“We Want to be Treated as Human”

Summary

"The funding cuts, combined with the reduction in civic space and the further criminalisation of marginalised populations have come together to create the biggest storm the HIV response has ever seen."

- Winnie Byanyima, Executive Director of UNAIDS

By December 2024, the world was the closest it had been since the peak of the HIV/AIDS pandemic to ending AIDS as a public health threat by 2030, according to the United Nations Programme on HIV/AIDS (UNAIDS). Nearly 80 percent of people living with HIV were on lifesaving treatment, new infections had decreased by 40 percent since 2010, and the number of AIDS-related deaths had dropped more than 50 percent. Then, within hours of taking office on January 20, 2025, United States President Donald Trump froze all foreign development assistance, including the President's Emergency Plan for AIDS Relief (PEPFAR), which over the previous 21 years had been credited with saving 25 million lives. The cuts plunged global health programs into crisis, putting millions of lives at risk and threatening to undo decades of hard-won progress towards controlling and eliminating HIV/AIDS.

Because the US had provided roughly 75 percent of all international funding for the HIV/AIDS response, the sudden withdrawal dismantled much of the HIV/AIDS prevention, care, and pharmaceutical supply chain infrastructure overnight. Clinics were forced to ration medications or cut distribution altogether, researchers halted clinical trials mid-study, and outreach workers had to abruptly drop clients.

In early 2025, following a pause of all foreign development assistance, the Trump administration began dismantling the United States Agency for International Development (USAID). On July 1, USAID was formally shuttered, terminating most USAID programs and shifting all remaining functions to the State Department.

A Kaiser Family Foundation analysis indicates that 80 percent of USAID health programs were terminated, totaling US$12.7 billion. Among the programs that were closed, 379 were HIV/AIDS grants-accounting for over 70 percent of all HIV/AIDS funding under USAID. According to an estimate by the Center for Global Development, the terminated grants under USAID for HIV/AIDS had supported approximately 2.3 million people on lifesaving treatment. The consequences have been catastrophic: according to one estimate, more than 170,000 additional people died in one year (January 24, 2025 - January 24, 2026) because of the cuts to HIV/AIDS prevention and care.

According to a July 2026 report by the Kaiser Family Foundation and UNAIDS, the US spent US$2.1 billion less on HIV/AIDS global health response in 2025 compared to 2024. Yet whether this represents the totality of US HIV/AIDS funding cuts is unclear because the administration has been exceptionally untransparent in providing information. Much of the data on funding cuts has been cobbled together by non-governmental organizations. In March 2025 the Office of Management and Budget (OMB, within the executive office of the president) took its public apportionment-tracking website offline. The site was restored in August 2025 only after a court order. In February 2026, Physicians for Human Rights and the Council for Global Equality sued the State Department for failing to release FY2025 PEPFAR performance data and FY2026 budget/planning documents despite multiple Freedom of Information Act requests. Senators from both parties have had to send repeated formal document requests to uncover how money already appropriated was being classified and spent. Senate Foreign Relations Committee Ranking Member Jeanne Shaheen wrote in June 2026 that the State Department "has still not sent to Congress the final list of approximately 5,600 terminated foreign assistance contracts and awards, including the rationale for the termination of each program... despite repeated requests for more than one year," and asked for monthly briefings on close-out costs.

In 2025, the administration also attempted to cut PEPFAR funding, which is overseen by the State Department and included some of the cut USAID programs as well as programs outside of USAID. In July 2025, the Trump administration proposed a plan for Congress to claw back billions of dollars of previously allocated foreign assistance funds, including cutting an additional $400 million from PEPFAR. While the rest of the recission package passed, Congress ultimately removed the PEPFAR cuts in late July 2025 due to objections from legislators, including Senators Collins and Murkowski, thus maintaining appropriations for HIV/AIDS at previous funding levels of around $6 billion.

It became clear throughout FY2025 that the OMB was barely apportioning the PEPFAR funds appropriated by Congress, raising questions of whether congressionally appropriated funds for HIV/AIDS were making it to people who needed them. The New York Times reported in August 2025 that with just under six weeks left in the fiscal year, OMB had apportioned only $2.9 billion of the $6 billion Congress had appropriated for HIV/AIDS in FY2025, a figure closely matching the administration's own FY2026 budget request rather than what Congress had mandated. Notably, FY2025 appropriations for HIV/AIDS aren't subject to a single hard deadline. Most of the $6 billion Congress appropriated carries five-year availability, meaning it can legally still be obligated through FY2029. Only a smaller USAID-administered slice (about $330 million) is on the standard two-year clock, requiring obligation by the end of FY2026, which ends September 30, 2026. In August 2026 the New York Times reported thatnearly half of the $3.485 billion in global health appropriations that needed to be obligated by September 30 remained unobligated, which, according to reporting by The Hill, includes at least $300 million that was specifically earmarked for HIV/AIDS programs. As the September 30 deadline approached, the Department of State committed nearly all of the remaining funds, including by reportedly transferring some $2.5 billion into a non-expiring 'miscellaneous' account. While it is a positive move that the Department of State was able to prevent the funds from expiring, questions remain whether funds appropirated to HIV/AIDS response will be obligated to those projects.

The abrupt and sweeping nature of the cuts also set a dangerous international precedent. Over the course of 2025, the US withdrawal was followed by precipitous withdrawals of other major donors from financing the HIV/AIDS response, including France, Japan, and Germany. In June 2026, Winnie Byanyima, executive director of UNAIDS, said of the global funding cuts: "There's no question that this is the most serious disruption in the HIV response since the world came together to fight this disease." The Global Fund to Fight AIDS, Tuberculosis and Malaria received pledges of only US$12.64 billion of an urgently needed $18 billion during its eighth Replenishment cycle at the end of 2025, with all but one of the Fund's 10 leading donors reducing their pledges. In February 2026, France announced that it would reduce its contribution to the Fund by nearly 60 percent, despite having previously been the second largest donor after the US and a founding member of the Fund. The impact of the global cuts to HIV/AIDS care and prevention has been and will continue to be profound. According to UNAIDS:

People living with HIV have died due to service disruptions, millions of people at high risk of acquiring HIV have lost access to the most effective prevention tools available, over 2 million adolescent girls and young women have been deprived of essential health services, and community-led organizations have been devastated, with many being forced to close their doors.

Human Rights Watch is investigating the impact of cuts to US foreign aid for HIV/AIDS prevention and care, especially for populations that are structurally excluded or targeted. This report documents the consequences in Indonesia and particularly its impact on transgender people and men who have sex with men (MSM), who were primarily relying on foreign aid-funded HIV/AIDS support services because of their own government's exclusion and hostility. According to the government's foreign assistance tracking website, obligated funds for HIV in Indonesia dropped $4 million from $11.9 million in FY2024 to $7.9 million in FY2025.

The cuts to HIV/AIDS funding combined with the Indonesian government's targeting of lesbian, gay, bisexual and transgender (LGBT) people threatens to reverse decades of progress in Indonesia's HIV/AIDS response and condemns thousands of people to preventable illness and death. This report documents the consequences of this dual crisis through interviews in November 2025 and June 2026 with 35 healthcare outreach workers, people living with HIV, activists, aid recipients, academics, and nongovernmental organization staff. It situates these findings within the broader context of sexual orientation and gender identity-related discrimination and violence against LGBT people in Indonesia, drawing on over a decade of documentation by Human Rights Watch. What emerges from these interviews is a preventable public health crisis unfolding in real time.

The HIV/AIDS epidemic in Indonesia is described as a "concentrated epidemic," meaning that while the prevalence rate in the general population is steady and below 1 percent, the prevalence rate in a key affected population is above 5 percent. In Indonesia, with the exception of the Papua provinces, where the epidemic is generalized at 2.3 percent, the national general population prevalence rate sits at 0.4 percent. By contrast, the prevalence rates for transgender people and MSM in Indonesia are 25 percent and 22 percent, respectively-at least 50 times higher than the general population.

Despite these populations facing a significantly higher risk of HIV transmission, domestic spending in Indonesia on HIV/AIDS care severely neglects them. According to the most recent comprehensive data available, Indonesia domestically spent just over $80 million on HIV/AIDS prevention and treatment in 2020, but only 0.1 percent ($102,000) went to programming for MSM and nothing was spent on programs specifically reaching transgender people. In essence, the government is failing to invest in responding to the HIV/AIDS epidemic where it is needed most, undermining an effective response to the epidemic writ large. As UNAIDS notes in its Global Action Framework for Country-led Responses, "focusing HIV prevention efforts on key populations and their partners remains a highly effective way to reduce population-level HIV transmission."

Discrimination and stigma fueled by the Indonesian government's anti-LGBT policies and harmful rhetoric create additional barriers for LGBT Indonesians to access prevention and care, making population-specific, community-based outreach critical to combating the concentrated epidemic.

"Rather than prevent HIV, the government targets LGBT people and promotes discriminatory policies," said Kamel, the program manager of Yayasan Srikandi Sejati, a grassroots organization of transgender outreach workers living with HIV in Indonesia. Abusive and discriminatory police actions, including raids on private spaces and the use of condoms as evidence of purported crimes, have harmed HIV education and outreach services in Indonesia by instilling fear among LGBT populations who urgently need such services. "HIV prevention or HIV status becomes evidence of being gay, and LGBT identity is criminalized," one LGBT rights lawyer and activist said. Fear of non-confidentiality, rejection, and discrimination when attending government clinics remains a barrier to accessing care services.

These systemic barriers create a gulf between LGBT populations and mainstream HIV care, especially when government officials, politicians, and powerful religious institutions drive anti-LGBT stigma and discrimination. For example, in response to Pride Month celebrations in June 2026, the conservative Majelis Ulama Indonesia (Indonesian Ulama Council) declared that "sexual deviation" should carry criminal penalties heavier than adultery, and prepared a draft law to criminalize anyone campaigning for the rights of LGBT people. In October 2025, President Prabowo Subianto signed a decree concerning Indonesia's national defense policy, which stated that national security threats also come from "non-military factors" including "the spread of LGBT culture." The decree, which was only made public in July 2026, called on parents to monitor their children with "this lifestyle." This pervasive political rhetoric foments stigma and discrimination, effectively condones violence against LGBT people, and discourages people from practicing safer-sex and seeking care. If LGBT people fear they are being monitored by their family members, for example, they may feel unsafe carrying condoms, seeking HIV testing, or even getting HIV medications to prevent transmission and the progression to AIDS.

To ensure that MSM and transgender people have access to HIV services despite this hostile environment, international donor-funded organizations have worked with peer educators and outreach workers to bring HIV information and testing to MSM and transgender people outside of clinics. In addition, outreach workers have accompanied MSM and transgender people to clinics to receive medication for HIV prevention and care, and trained healthcare providers in non-discriminatory and affirming care. Of the $5 million spent on such HIV/AIDS interventions for MSM and transgender populations in Indonesia in 2020, 98 percent was covered by international funding. With the help of foreign funding, these local organizations have been able to navigate the high-risk political environment to be able to reach LGBT populations in need of prevention services and to enable access to care. Now those most at risk of HIV/AIDS in Indonesia have essentially been abandoned, subject to criminal prosecution by their government and forsaken by major international donors.

The aid cuts in Indonesia have seriously affected community-based organizations doing outreach to transgender and MSM populations. Community-based healthcare workers provide a critical lifeline to overcoming the barriers created by criminalization, stigma, and discrimination. As Indah R., a wariaoutreach worker living with HIV, explained: "Just leaving the house as a trans person is scary. Without an outreach worker, the person will be alone and they won't get care."

In Indonesia, all community-led activities for HIV/AIDS care and prevention for LGBT populations funded through USAID were cut, especially impacting outreach workers, many of whom are living with HIV and identify as gay or waria themselves. Multiple outreach workers said they were hearing from their clients that they were no longer obtaining antiretrovirals - medications that suppress HIV, preventing it from progressing to AIDS or being transmitted to others. Many outreach workers reached into their own pockets to pay for transportation for their clients to continue receiving antiretrovirals. A gay activist living with HIV captured the severity of the crisis:

"[T]he issue is that we are losing the people who were linking high-risk people to accessing care.… The people who lost the follow-up from outreach workers, who will bring them to the facilities? This has been done forever by the NGOs. If you are LGBT and living with HIV, it's the end of the story, you are doomed."

The cuts also impacted community-based organizations that were conducting testing and measuring prevalence rates. This means that while cases may be rising due to a lack of outreach and a drop in medication usage, the true magnitude of transmission is unknown.

The role of international funding in filling a gap in care left by the neglect of transgender and MSM populations in the domestic HIV/AIDS budget extends beyond Indonesia and reflects the global impact of the USAID withdrawals on care for marginalized populations. A report on the impacts of the funding freeze published in February 2025 by Outright International, an LGBTIQ advocacy rights organization, found that "In countries where health care systems discriminate against LGBTIQ persons or do not provide LGBTIQ-inclusive care, LGBTIQ organizations that fill such critical gaps have had to halt or scale down their operations." A September 2026 report on the impacts of the cuts for LGBTI populations in the Asia-Pacific by APCOM, a non-governmental organization, found that:

"The disruption extended across referral networks linking health, legal, and social services, many of which are essential lifelines for LGBTQI individuals facing discrimination, violence, or criminalisation. Breakdowns in these networks meant interrupted access to HIV services, mental health support, emergency shelter, and legal representation, often in contexts where alternative pathways do not exist."

The increased risk created by the funding cuts in Indonesia is compounded by the entry into force of Indonesia's new criminal code on January 1, 2026, which effectively criminalizes same-sex conduct for the first time in Indonesia's history. The new code makes all consensual sex outside of (heterosexual) marriage a criminal offense, allowing parents, children, or spouses to file a police report against married or unmarried individuals. The timing of the funding cuts means that just as services disappear, the legal environment makes it even more dangerous for LGBT people to seek the care that remains.

Ending AIDS as a public health threat by 2030 remains achievable, but only if donors respond to the crisis with funding for non-discriminatory and evidence-based approaches. This means investing in community-based outreach and prevention, harm reduction, and access to affordable treatments and therapeutics. Donors should increase support for the Global Fund, and the Fund should prioritize funding to community-based organizations working with key populations given the impact of the withdrawal of international funding for these groups. As UNAIDS warned in its 2026 Global AIDS Brief, the world can end AIDS as a public health threat by 2030 "only if countries, communities and all partners act decisively and make the political choices required to put people first. Without this commitment, countries risk seeing a resurgence of the HIV epidemic and losing decades of progress."

The high HIV/AIDS prevalence among MSM and transgender people in Indonesia is, in many cases, a symptom of systemic discrimination. The Indonesian government should immediately repeal legislation used to target LGBT people, including articles of the new criminal code that do not conform with Indonesia's international human rights obligations. The police should immediately stop unlawful raids targeting LGBT people and investigate and appropriately discipline or prosecute officers responsible for such raids. Any regional or local police units dedicated to targeting LGBT people should be dissolved. The government should prosecute members of vigilante groups targeting LGBT people on social media and in person. The government should work closely with LGBT organizations to ensure HIV/AIDS prevention and care strategies are non-discriminatory and inclusive. The Ministry of Health should ensure the adequacy of the budget for HIV/AIDS prevention and care for key populations, including MSM and transgender people. The ministry should partner with community-based organizations to provide outreach to key populations and train doctors, nurses, and other health workers to provide affirming, safe, and non-discriminatory care for LGBT patients.

Methodology

Human Rights Watch conducted research for this report in November 2025 and in June 2026, including 35 interviews with people living with HIV; LGBT HIV/AIDS outreach workers; HIV/AIDS civil society organizations; and human rights activists in Jakarta, Depok (West Java), and Serang (Banten). Of the eight organizations that we spoke with, half had been significantly impacted by the USAID cuts. We additionally reviewed budget and policy documents related to the USAID cuts and impacts in Indonesia.

Human Rights Watch wrote to the US Department of State and to the Indonesia Ministry of Health and Ministry of Home Affairs on September 24, 2026, regarding the impact of the cuts. These letters are included in the annex to this report.

We conducted interviews in safe locations, sometimes far from the interviewee's home neighborhood or city. The names of nearly all LGBT individuals in this report are either withheld or replaced with pseudonyms. In some cases, we have withheld the location of interviews and other potentially identifying characteristics of interviewees for security purposes. Interviews were conducted in English and in Bahasa Indonesia with English interpretation. Interviewees were informed how the information gathered would be used and told that they could decline the interview or terminate it at any point. Transport costs were reimbursed and no other payments were made to interviewees.

Indonesia's HIV Crisis and the USAID Cuts

Indonesia's HIV epidemic is highly concentrated among men who have sex with men (MSM), transgender women, and people who inject drugs. While adult HIV prevalence nationally sits at around 0.4 percent, it exceeds 20 percent among MSM and reaches 25 percent among transgender women; that is 50 to 62 times higher than the general population. In some urban centers the rates are even higher: a 2021 respondent-driven sampling study in Bandung found that 30 percent of MSM ages 15 to 24 were HIV-positive. In Denpasar, Bali, MSM prevalence exceeds 38 percent, according to the Indonesian Ministry of Health's 2019 Integrated Biological and Behavioral Survey.

These striking prevalence rates are driven by structural discrimination and institutionalized stigma and discrimination. Over many years, the Indonesian government has driven HIV testing, prevention, and treatment underground and created systemic barriers to accessing safe and reliable health care by targeting and criminalizing LGBT Indonesians. This state-led persecution meant community-led organizations often served as the only lifeline to safe testing, prevention, and care for LGBT people in Indonesia. When the Trump administration dismantled USAID, thus terminating much of the funding for these groups, these services were suddenly unavailable.

The impact of criminalization of same-sex relations on HIV prevalence has been documented across contexts for many years. A 2010 United Nations Development Programme report, for example, found that criminalization of same-sex sexual activity was harming the response to HIV in the Asia-Pacific region. The report described how police harassment of MSM and transgender outreach workers disrupted prevention and care services, and how police raids, like those ongoing in Indonesia, blocked people from gathering where they might access information, services, and support. A 2017 study in the Health and Human Rights Journal reported that a cross-sectional survey of 556 MSM and 137 transgender women found that HIV-positive status was independently associated with higher odds of police harassment for both groups. Similarly, a 2004 Human Rights Watch report in Jamaica found that severe homophobia and violence against MSM were fueling the HIV/AIDS epidemic. Police routinely beat, harassed, and arrested gay men and HIV outreach workers while health workers frequently denied care, breached confidentiality about HIV status, and publicly humiliated patients. As a result, many at-risk people avoided testing and treatment altogether out of fear, worsening transmission. A 2023 study published in the Lancet, based on data from 10 Sub-Saharan African countries over nine years, found that MSM in countries with laws criminalizing same-sex activity are five times more likely to have HIV than MSM in countries with no criminalizing laws, and if there have been recent prosecutions under sodomy laws, MSM are 12 times more likely to have HIV. The study also found that MSM in countries where civil society organizations expressly working with LGBT populations are not allowed to legally register are 10 times more likely to have HIV than MSM in countries where such organizations can legally register. A 2025 study in the Journal of the International AIDS Society looked at community-led monitoring data before and after the 2023 Anti-Homosexuality Act in Uganda across 320 health facilities and 50 drop-in centres. The study found that after the passage of the Anti-Homosexuality Act, there was a significant drop in MSM clients' accessing HIV-related services.

The Indonesian government has also significantly neglected MSM and transgender people in the national budget for HIV prevention and care, despite these populations facing some of the highest risks of transmission and illness. While the Indonesian government has significantly ramped up its domestic funding for HIV/AIDS response-increasing 400 percent from US$26.7 million in 2010 to over $109 million in 2022-government spending on HIV/AIDS conspicuously neglects key affected populations. According to the most recent comprehensive data available, Indonesia domestically spent just over $80 million on HIV/AIDS prevention and treatment in 2020, but only 0.1 percent of that ($102,000) went to programming for MSM and nothing was spent on transgender programs. International funding filled that gap, covering 98 percent of the funding for HIV/AIDS in Indonesia for MSM and transgender populations in 2020. According to UNAIDS financial estimates in 2024, less than 10 percent of domestic spending in Indonesia for HIV/AIDS went towards prevention programs specifically designed to reach key affected populations - half of the 20 percent UNAIDS recommended to be allocated for prevention for key populations.

Indonesia has mandatory district-level guidelines that set coverage targets for basic health services, including HIV, called Minimum Service Standards (Standar Pelayanan Minimal, or SPM). Achievement data illustrate the effects of this gap on outreach to MSM and transgender populations. A 2024 study examined HIV service coverage at Puskesmas Bukit Sangkal, a government-run community health center in Palembang, South Sumatra, selected for the study because it recorded one of the highest HIV service coverage rates among puskesmas (government community health clinics) in the city. Despite this, the study found that while HIV service coverage for pregnant women exceeded its target by more than 25 percent, coverage for MSM reached only 4.4 percent (3 out of 68 individuals targeted for outreach), and coverage for transgender people was zero. The study attributes these failures to social stigma, discrimination, and limited access to formal health services, compounded by a lack of healthcare worker training in engaging key populations.

Criminalization Fueling an Epidemic

In 2016, a wave of inflammatory anti-LGBT statements from senior Indonesian government officials triggered a nationwide crackdown that Human Rights Watch documented in a 2018 report, "Scared in Public and Now No Privacy."Police raids on saunas, nightclubs, hotels, and homes spiked sharply, with at least 300 LGBT people arrested in 2017 alone because of their sexual orientation and gender identity, often subjecting them to public humiliation and to the use of condoms as criminal evidence. Critically, many of the raided venues also served as HIV testing and outreach hubs for MSM. Because condoms became proof of criminal conduct, MSM increasingly refused to carry or accept condoms for fear of arrest, depriving themselves of one of the most basic tools of HIV prevention. An MSM HIV outreach worker in Jakarta told Human Rights Watch in 2017 that handing out condoms felt like "asking people to smuggle illicit drugs."

A decade later, authorities continue to harass LGBT communities with raids, detention, surveillance, and abuse, further driving LGBT people away from safe health care and undermining safer sex practices. After the criminal code went into effect, LGBT people are "a bit worried to get together," said Ratna F., a waria outreach worker living with HIV. "We haven't really been gathering." But such gatherings were a place where Ratna would identify and connect with new clients. Without being able to gather, she said, it is difficult to distribute condoms or to help new clients get tested or access to antiretroviral drugs (ARVs).

Police in Indonesia continue to use condoms as evidence of criminal behavior. In February 2026, police raided a hotel and arrested 56 men in Jakarta, under the anti-pornography law, collecting condoms and "HIV medication" as evidence. In June 2025, police arrested 75 people during a raid on a "gay party" in Bogor, West Java, using condoms as evidence. In October 2025, police arrested 34 men under the anti-pornography law in Surabaya, East Java, again using condoms as evidence. They reportedly zip-tied the detainees' hands together and paraded them in front of the press. One LGBT rights activist living with HIV said: "If they bring condoms or use PrEP, that means they are being safe. It means they know what to do to prevent transmission. But then the use of prevention is used as proof of a crime." "In Indonesia, trans people are stigmatized and they say the source of HIV is trans people," said Yulianus "Mami Yuli" Rettoblaut, whoheads the Forum Komunikasi waria Indonesia, the largest waria organization in the country. "Transgender people are human," Mami Yuli said. "We just want to be treated as human."

Cutting the Lifeline: USAID Cuts and the Collapse of Community Care

In the face of systemic discrimination and abuse, community-based healthcare workers often provide a critical lifeline to accessing care. Community-based outreach and healthcare workers in Indonesia, many of whom are gay or transgender and living with HIV themselves, serve as a trusted source of health information and support. They play an important role in reaching marginalized populations to carry out testing, distribute condoms, PrEP, and share information about prevention. They serve as a first line of support when someone tests positive for HIV, helping them to access antiretrovirals to suppress the virus and maintain treatment protocols. They provide support navigating an often-stigmatizing healthcare system and carry out trainings with public health care workers to provide affirming, safe, and non-discriminatory care for LGBT patients.

Asmara E. said she tested positive for HIV this year and that her outreach worker has been pivotal in helping her navigate this new information. "It is a lot to process and face what happened," she said. "It is new and there is a lot that I don't know. My outreach worker helps me with all of this." This outreach is critical in a context where accessing public services can mean exposure to stigma and discrimination. Indah R., a waria outreach worker living with HIV, said: "Just leaving the house as a trans person is scary. Without an outreach worker, the person will be alone and they won't get care."

The lifesaving role of community-based outreach is supported by a growing body of research. According to the 2025 UNAIDS global report:

Community-led organizations, particularly in peer-supported services, have been shown to increase testing uptake, improve adherence to antiretroviral therapy, strengthen retention in care, achieve higher levels of viral load suppression, and reduce vertical transmission in multiple settings and countries. Funding losses have now forced many community-led and other nongovernmental organizations to reduce or cease their HIV activities.

Community-led services were hard hit by the USAID cuts. Globally, 40 percent of the 70 UNAIDS country offices surveyed in April 2025 said that the cuts had stopped some community-led services in their country. A 2026 study surveying 79 community-led organizations across 47 countries showed an 85 percent reduction in services directed towards MSM.

In Indonesia, all community-led services for HIV/AIDS funded through USAID were stopped when the Trump administration initially paused US foreign development assistance in early 2025, and none of those directed toward LGBT populations were resumed.Yayasan Srikandi Sejati (YSS), a grassroots organization of transgender outreach workers living with HIV, had all funding cut and had to abruptly stop outreach to the approximately 40 to 50 people that each worker was supporting. YSS went from 23 transgender outreach workers living with HIV to 11 sustained by an emergency grant from Canada that expired after February 2026. As of June 2026, YSS has no funding and the remaining 11 outreach workers are working as volunteers. Some, having worked with their clients for more than 10 years, refuse to abandon them now. "Right now, it is very difficult to work as an outreach worker without money. But I push myself to help others with anything I have," said Setia L., a waria outreach worker living with HIV.

Jaringan Indonesia Positif (JIP), the largest nongovernmental organization for people living with HIV in Indonesia, went from 150 staff to about 30 because of the cuts; 15 of whom remain on an essentially volunteer basis carrying out a study to measure the impacts of the cuts. Those who were cut had been doing outreach to people who had stopped treatment and doing advocacy with puskesmas on providing non-discriminatory and de-stigmatizing care to LGBT patients. The majority of staff were living with HIV and were MSM or transgender persons themselves. Multiple interviewees from different organizations said that some former outreach workers have since taken up sex work because they were unable to find alternative employment, which Kamel, the director of YSS, explained put them "at risk of more violence and HIV."

Disruptions to Testing, Prevention, and Monitoring

In a context where police use condoms as criminal evidence and same-sex sexual activity is now essentially criminalized, community-based outreach workers are often the only people whom LGBT Indonesians could trust to access testing, prevention, and care without fear of exposure or arrest. Losing these workers overnight eliminated logistical support for testing as well as condom and PrEP distribution and trusted relationships that made engagement with health services possible. The funding cuts that created these gaps also eliminated much of the infrastructure that would have measured them. Without outreach workers, key populations lose access to regular safe testing and monitoring of prevalence rates. The result may be an epidemic that worsens in the darkness.

Access to Testing

Outreach workers play an important role in helping people get testing. Kamel, the director of YSS, described the impact of the funding cuts: in 2025, YSS helped 1,700 transgender people access HIV testing through community-based outreach. Waria outreach workers living with HIV built trusting relationships in their community to make testing safe and accessible for LGBT people. Now, operating without funding, the organization can only reach those who come forward voluntarily because they cut outreach workers and can no longer afford to host events or travel to meet people. "Before we could do outreach to people who were more hesitant," Kamel said. A grassroots HIV/AIDS and tuberculosis (TB) outreach organization in Serang used to organize community testing events with workers from puskesmas (government community health clinics), for example, but these programs have since been cut.

The lack of HIV testing and overall measurements means that while cases may be rising due to a lack of outreach and a drop in medication usage, the true magnitude of HIV transmission is unknown. A field coordinator for a grassroots HIV/AIDS and TB outreach organization in Serang said: "Before the cuts, we could gather people and test more. Now, because of the cuts, the number of cases now is unknown." Kamel explained that since YSS ran out of emergency funding from Canada in February 2026, volunteer outreach workers have been focusing their time on maintaining contact with their clients but do not have the capacity to take notes or report back to inform YSS statistics. They are not able to measure, for example, how many clients workers are maintaining, how many are lost to follow up, how many are staying up on ARVs and how many new clients are getting tested and what the results are. According to UNAIDS' 2025 report on the impact of the funding cuts, the sudden drop in monitoring is a global problem:

Data monitoring in many countries has been curtailed due to cuts in funding because the data management staff were funded through the United States Government…. Many community-led monitoring activities have been discontinued or reduced, undermining what has been an increasingly important source of person-centred data on the quality, reach and impact of services.

Disruptions to Treatment and Care

HIV becomes non-transmissible and is no longer life-threatening when antiretroviral medication consistently suppresses the viral load to undetectable levels. An estimated 570,000 people are living with HIV in Indonesia, but just around 40 percent are accessing treatment and just 14 percent are virally suppressed. This means that beyond prevention, ensuring reliable access and adherence to antiretrovirals is a top priority, with an emphasis on outreach to the populations with highest prevalence rates.

HIV treatment requires regular testing to monitor viral load and ongoing adherence to medication. Outreach workers have long guided people after a positive test; helping clients understand their diagnosis, accompanying them to appointments, and covering costs that stand between a positive result and treatment. To access antiretrovirals, a person who tests positive must first undergo a viral load test, which costs IDR190,000 (US$11). Outreach workers previously had funds to cover this cost for clients who could not afford it. Several outreach workers told Human Rights Watch that, unwilling to abandon their clients, they are now paying for both the test and transportation to the clinic out of their own pockets. It is recommended that people living with HIV take an annual CD4 test-which measures immune system function-at a cost of approximately 350,000 IDR ($20). Workers said their clients are increasingly skipping this test because they cannot afford it.

Outreach workers said that part of their work was to ensure that participants were regularly accessing testing and receiving antiretroviral medication. Missing HIV medication doses lets the virus start multiplying again, because drug levels in the blood drop too low to stop it. When the virus multiplies while some drug is still present at low levels, it can develop resistance not only for the current drug but for others as well. As the virus increases, CD4 cells drop: CD4 cells are white blood cells that fight infection and are the main cells HIV attacks, so a lower CD4 count means weaker immunity and higher risk of getting sick from infections. Missing doses also brings back the risk of spreading HIV to others. HIV is not transmissible when the viral load is undetectable. If the virus rebounds to detectable levels, it becomes transmissible.

After the funding cuts, outreach workers said they were hearing from their clients that they were no longer obtaining medication. Ratna F. said, "I lost contact with many participants, who are now late getting meds." She said that months later health care workers from the local puskesmas called to tell her that some of her clients were not coming to pick up their ARVs. Kamel, the director of YSS, said: "Before the cuts, outreach workers were in touch 24 hours a day to remind people to take medication and to provide support. Now assistance is diminishing and people are missing doses."

Aisha E., a waria outreach worker living with HIV, noted that organizations can no longer afford to send antiretrovirals by courier to their clients outside of Jakarta. Previously, funding would have covered the courier fee. Because this is no longer covered, patients outside of Jakarta who cannot afford to travel to the city to get antiretrovirals must pay the courier upon delivery. However, in many cases, this is cost prohibitive. "Antiretrovirals are free but some can't afford the admin fee of 15,ooo IDR [$0.89] every month in addition to the cost of transportation," Aisha said. For members of marginalized communities already struggling economically, these costs become insurmountable obstacles. This reality forces impossible choices, as Nurul R., a waria outreach worker living with HIV observed: "People set aside their medical concerns to focus on livelihood if they are barely surviving." Many community health workers reached into their own pockets to pay for transportation for their clients to continue receiving antiretrovirals.

Community-based organizations' role in destigmatizing health care

Community-based outreach workers provided critical support to LGBT patients navigating health care settings where stigma and discrimination are routine. Ratna F., a waria outreach worker living with HIV, said that transgender people face "stigma when they enter a new [public health clinic]. The place is more friendly if there is an outreach worker accompanying them." Belinda Hutapea, the national coordinator for Ikatan Perempuan Positif Indonesia (Indonesia Women Positif, IPPI), an organization for women living with HIV, said that her organization "becomes the bridge between the community and health facilities. Without this, many women will feel uncomfortable to access services. They are afraid to go on their own because of stigma. They need the support of IPPI workers to access facilities."

In Indonesia it is common that LGBT people will be kicked out of their homes or will flee domestic violence and find themselves without formal identification documents. Lina Zurlia, an LGBT rights activist, said: "Many queer people run away from home before they are 18 and they don't get IDs." Access to government-provided health insurance, Jaminan Kesehatan Nasional (JKN),is based on family-unit registration, meaning that every individual in a household must register under one joint family insurance card (kartu keluarga) with one shared insurance number. For young LGBT people who left their childhood homes, they might therefore be stuck without health insurance. Community-based organizations that were previously funded by USAID would work with LGBT clients to register as independent households or sometimes together as a family unit to obtain the documentation necessary to access health care, including PrEP, testing, and ARVs.

For transgender peoplethe process is additionally complicated because the national identity card (kartu tanda penduduk, KTP) required to access health care and other government services includes a binary gender marker (male or female) based on the sex assigned at birth. This creates significant barriers for transgender people whose gender identity does not match their legal documents. Legally changing gender markers on the KTP is extremely difficult: it typically requires proof of gender-affirming surgery and court approval, which most cannot afford or access and is in many cases denied.

This documentation mismatch effectively excludes many transgender people from health care, forcing them to either avoid medical care entirely or endure humiliation, deadnaming (the act of referring to a transgender or non-binary person by their birth name or previous name after they have transitioned), public outing, and mistreatment when they do seek it. Many clinics, for example, use loudspeakers to call patients and will use the deadname of the patient because it is what is listed on their ID card. When an outreach worker accompanies clients to puskesmas they can advocate on their clients' behalf. "Clients feel the difference in treatment when the outreach workers assist them or when they have to go alone," said Kamel. Roro J., a waria client living with HIV, said: "If they come with an outreach worker, they call them by their name. but if they come without, then they call them by the deadname." She explained that this is because the outreach worker has built relationships at the clinic and can advocate for them to use the correct names.

Beyond facilitating their transgender clients' access to care, community-based health workers and LGBT organizations served a crucial advocacy function by building relationships with public health institutions and conducting trainings to encourage affirming and non-discriminatory health care for LGBT people. Audi Manaf, a waria activist living with HIV described the loss of this work with frustration: "We used to train puskesmas not to deadname trans patients. Now that's been cut" due to the drop in funding.Ayu M., an outreach worker-herself waria and living with HIV and engaged in sex work-emphasized that education requires sustained effort. She explained that every time a puskesmas hires new staff, "we have to rebuild relationships from scratch to shield our clients from discrimination." Now, without funding for community-based cared for MSM and transgender people with HIV, this shield is lost.

Human Rights Obligations

Indonesia is a party to core human rights treaties that guarantee the rights to health, privacy, security, and non-discrimination including the International Covenant on Civil and Political Rights (ICCPR), the International Covenant on Economic, Social and Cultural Rights (ICESCR), the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), and the Convention on the Rights of the Child (CRC).

Right to the Highest Attainable Standard of Health

The right to the highest attainable standard of health is guaranteed under the ICESCR and CEDAW. This right imposes an obligation on states to take necessary steps for the prevention, treatment and control of epidemic and other diseases. The UN Committee on the Rights of the Child, in its General Comment on adolescent health and development, said that in meeting this obligation, states "should ensure that appropriate goods, services and information for the prevention and treatment of STDs [sexually transmitted diseases], including HIV/AIDS, are available and accessible."

In its General Comment on the right to health, the UN Committee on Economic, Social and Cultural Rights stated that "the right to health is closely related to and dependent upon the realization of other human rights," including the rights to human dignity, access to information, and the freedoms of association and assembly. Emphasizing that the right to health contains both freedoms and entitlements, the committee stated the ICESCR "proscribes any discrimination in access to health care and the underlying determinants of health, as well as to means and entitlements for the procurement, on the grounds of … sexual orientation."

"Accessibility" is particularly relevant in Indonesia where access to essential HIV services for LGBT people and MSM has been severely compromised since 2016. In General Comment No. 14, the CESCR stated:

Health facilities, goods and services have to be accessible to everyone without discrimination, within the jurisdiction of the State party. Accessibility has overlapping dimensions, including inter alia, nondiscrimination in law and in fact - especially of vulnerable or marginalized sections of the population and information accessibility - the right to seek, receive and impart information and ideas concerning health issues.

The anti-LGBT crackdown that began in January 2016 has compromised the right to the highest attainable standard of health, both by impeding the work of health and HIV prevention groups (particularly those composed of LGBT people), and by imposing new risks for individual LGBT people who seek health services that may require revealing their sexual orientation or gender identity. Police interference with people's ability to access condoms or health information from peers impedes their rights to life and health and is incompatible with human rights standards.

Right to Privacy

The criminalization of same-sex conduct between consenting adults violates the right to privacy and the right to freedom from discrimination, both of which are guaranteed under the ICCPR.

The UN Working Group on Arbitrary Detention has determined that arrests of persons on the grounds of sexual orientation and for "having peacefully exercised their right to freedom of opinion and expression" can amount to arbitrary deprivation of liberty. Article 9 of the ICCPR guarantees everyone the right to liberty and security of the person; it prohibits arbitrary arrest and detention. The UN Human Rights Committee, the independent expert body that interprets the ICCPR and monitors state compliance, stated that article 9 guarantees these rights to everyone, including lesbian, gay, bisexual and transgender persons.

Recommendations

To the Indonesia Ministry of Health

• Provide adequate support in the budget for HIV/AIDS prevention and care for MSM and transgender people.

• Seek to ensure, in accordance with targets outlined in the UNAIDs Global AID Brief, that 30 percent of HIV treatment and prevention is delivered by community-led organizations.

• Ensure that all training for doctors, nurses, and other health workers address nondiscrimination and sexual health issues affecting LGBT people.
• Fund and consult with MSM and transgender HIV groups to implement an effective response to HIV prevention and treatment.
• Undertake a public information campaign to encourage key populations to access PrEP.
• Ensure all clinics always have adequate availability of ARVs and spread awareness that "undetectable = untransmissible" when it comes to HIV.

To the Indonesian National Police (Polri)

• End police raids targeting LGBT people and investigate and appropriately discipline or prosecute officers responsible for unlawful raids, and dissolve any regional and local police units dedicated to targeting LGBT people.
• Drop charges and release from custody anyone arbitrarily detained or prosecuted under the pornography law.
• Order all police forces to protect gatherings of sexual and gender minorities from threat or attack by militant Islamist groups or other vigilantes.

To the Indonesia Ministry of Law

• Review all district and provincial by-laws to ensure that they conform to constitutional guarantees and Indonesia's international human rights obligations on non-discrimination and respect for individuals' private life, including their sexual or gender identity.
• Immediately repeal legislation used to target LGBT people, including articles of the new criminal code that do not conform with international human rights standards.

To the Indonesia Ministry of Home Affairs

• Direct all provincial, district, and municipal governments to repeal all discriminatory bylaws that contravene the Indonesian constitution or violate international human rights law.
• Consult with nongovernmental organizations to develop non-discrimination training for all police forces across the country, including training on sexual and gender diversity.

To International Donors

• Significantly increase funding to the Global Fund.

• Support LGBT-led community-based organizations responding to HIV/AIDS in Indonesia.

To the US Administration/Congress

• Publicly disclose the criteria, processes, and assessments used by the administration to suspend or terminate foreign assistance programs, including any consideration of risks to affected populations.

• Conduct a comprehensive independent review (for example, through inspectors general) to assess the consequences of the 2025 aid reductions and program terminations, including their effects on access to essential services, protection of at-risk populations, and accountability efforts.

• Prioritize the continuity of funding for PEPFAR and obligate all funding in a timely manner.

• Make data on foreign funding cuts immediately available, including PEPFAR performance data and budget/planning documents and provide to Congress a list of all terminated foreign assistance contracts and awards, including the rationale for the termination of each program.

• Withdraw the "Promoting Human Flourishing in Foreign Assistance Policy," which prohibits foreign aid recipients from working on reproductive rights, transgender rights, and diversity initiatives.
  

Acknowledgments

This report was researched and written by Julia Bleckner, senior health researcher in the Environment, Economic, and Social Rights Division at Human Rights Watch. Arvind Ganesan, director of the Environment, Economic, and Social Rights Division, reviewed and edited this report. This report was reviewed by a specialist in the Asia division. Alex Müller, director of the LGBT rights division, and Cristian González Cabrera, senior researcher in the LGBT rights division, reviewed the report. Nicole Widdersheim, Interim Washington Director, and Kate Weine, senior coordinator for Washington Advocacy, also reviewed. James Ross, legal and policy director, provided legal review; Sarah Jackson, deputy program director, and Eric Goldstein, senior consultant to the program office, provided program review. Production assistance was provided by Jack Spehn, senior coordinator in the Environment, Economic, and Social Rights Division, and Travis Carr, publications manager.