A year on, USAID cuts leave gap in Central Asia’s fight against tuberculosis, HIV

Jan 14, 2026

When he was diagnosed with tuberculosis in 2016, Georgi, then a worker in his 40s for the municipal water company in Bishkek, knew little about the disease beyond some stereotypes and what he learned from a public awareness campaign in grade school.

“The doctors don’t have time to explain beyond that it’s a disease,” he said. “And a person who simply doesn’t understand can get scared.” 

The state provided him with treatment and a bed in a government tuberculosis sanatorium on the shores of Lake Issyk Kul for a few months, but not much else. It was a web of non-governmental organizations that filled most of the gaps, providing nutritious food, distributing information and helping patients complete their treatments.

USAID was one of the largest donors, Georgi said, still able to recall the English words of the group’s slogan: “From the American People.”

“They [USAID] went around and helped people. They brought people medicine and tests, and, really, a lot of people survived tuberculosis and HIV because of that,” he recently recounted to Eurasianet.

During his treatment, which took about six months, he found a patient-led organization called TB People in Kyrgyzstan that offered those recovering from the disease assistance transitioning back to normalcy. Its work too was funded by USAID.

Just a little under a year ago, as US President Donald Trump returned to office and Elon Musk, the world’s richest man, revved up his budget-cutting chainsaw, Georgi saw everything that helped him heal disappear. 

The self-styled Department of Government Efficiency’s dismantling of USAID and the cancellation of millions in aid for tuberculosis and HIV/AIDS prevention efforts hit healthcare services hard across Central Asia, but especially in the region’s two poorest states, Kyrgyzstan and Tajikistan. 

The abrupt cutoff in funding shuttered some NGOs, reduced testing, eliminated patient support and left many in the country’s healthcare sector concerned that progress against comparatively containable diseases would stall, if not backslide.

“They drastically cut all the projects, and it led to collapse. We weren’t ready for that drastic of a cut,” Abdullo Muhmadov, the deputy director of the Tajikistan’s Republican Center for the Protection of the Population from Tuberculosis, told Eurasianet in his downtown Dushanbe office.

The center, which is directly government-run, previously had an annual budget of $18.3 million. The cancellation of USAID’s main, multi-year grant caused an approximate annual hit of $5 million, Muhmadov said late last year. NGOs have it worse. Before the USAID cuts, more than 20 organizations worked on tuberculosis prevention; now the number is down to three or four, he said.

Tuberculosis case detection decreased by approximately 30 percent during the first half of 2025 due to the cuts, according to Muhmadov.

Thirty-five field workers from Stop TB Partnership Tajikistan, an NGO, were spread out across the country’s rural, mountainous south, going door to door and screening people for symptoms when the email arrived in Akmal Khudoiberdiev’s inbox from the US government in late January 2025. It was an immediate stop-work order for any project funded by USAID, which was most of them.

Khudoiberdiev, the organization’s deputy director, scrambled to lay off the 35 field workers and 15 office staff that day, leaving only four employees, mostly working on a volunteer basis.

“If you consider our temperament, being a mountain country, yes, we’re taking it fine, but naturally, it was a big hit, especially for our families,” he said. “Tuberculosis won’t wait for us to get a new project.”

Stop TB’s work basically came to a halt until June, when the organization secured a grant from the Global Fund, a UN-backed entity that focuses on tuberculosis, HIV and malaria, to restart their outreach and testing work, but not their public awareness campaigns, Khudoiberdiev said as he walked through the now empty second floor of their office.

About 50,000 tuberculosis cases are reported annually across Central Asia. Kyrgyzstan and Tajikistan have the highest incidence rates, according to a 2025 World Health Organization monitoring report. Kyrgyzstan had a rate of 112 cases per 100,000 people and Tajikistan’s rate stood at 79 cases per 100,000 in 2023, according to the WHO. Tuberculosis rates in Central Asia had been falling sharply since the 1990s, but progress has stalled since the Covid pandemic.

The rural poor, prisoners and those living with HIV in the region have higher rates of tuberculosis, but infections are increasingly linked to labor migration, where tight quarters and poor nutrition contribute to the disease’s spread, NGO representatives say.

Tuberculosis often presents like other respiratory infections, making screening and testing vital. Treatment requires expensive antibiotics taken over several months during which patients are discouraged from doing manual labor, like construction. Patients sometimes give up treatment due to the length of treatment, stigma or side effects.

National government agencies and the UN have tended to be the primary providers of HIV and tuberculosis medicine and treatment in Central Asia. USAID allocated relatively little for treatment directly, NGO leaders told Eurasianet. However, the US agency was a significant funder for NGOs that conducted testing and supported patients through the lengthy treatment process.

“Even if there’s treatment, if there are no people for the treatment, that’s a problem too,” said Pulod Jamalov, director of SPIN Plus, a Dushanbe NGO.

The fate of HIV-focused initiatives remains up in the air. In the spring of 2025, it seemed as though state funding would be cut. But in mid-2025, organizations received word their funding is secure at least until March of this year, Jamalov said. Nonetheless, SPIN Plus, which runs a drop-in center for drug users, does outreach to sex workers and provides services in prisons, lost about 35 percent of its funding and a significant chunk of its staff following the USAID cuts, Jamalov said.

Jamalov has said his organization is hanging on by doing more with less, but many organizations are facing closure.

One organization under pressure is the Tajik Network of Women Living with HIV, a non-profit that organized support groups and advocated for women with HIV, a segment of society that experiences tremendous stigma and social isolation in Tajikistan. The cancellation of a signed USAID grant forced Takhmina Khaydarova, the group’s executive director, to all but shut down operations.

The Tajik government has made some progress in building its own capacity to address HIV and related issues in recent years, Khaydarova noted, pointing to the partial decriminalization of HIV transmission in late 2023 and the government’s purchase of 10 percent of the country’s antiretroviral drugs this year, a first. State agencies also plan to increase its funding of initiatives to combat tuberculosis over the next five years, according Muhmadov, the director of the Republican Center in Dushanbe.

The head of Kyrgyzstan’s national tuberculosis center, Abdullaat Kadyrov, told journalists last March that USAID’s project with the Kyrgyz government would continue, the local media outlet Kaktus reported.

In justifying USAID’s closure, Secretary of State Marco Rubio criticized the agency as a “dysfunctional” funding stream for the “NGO-industrial complex,” and claimed no one has died due to its shuttering.

Rubio has promised to make American foreign aid, now run through the State Department, leaner with an emphasis on direct compacts with recipient countries. “We’re going to do it the right way,” he said in a September 2025 ABC interview. 

Despite such words of assurance, Liliya Khan, the deputy director of TB People in Kyrgyzstan, of which Georgi was a member, remains worried. The organization has stopped its education efforts at mosques and community support after it lost 70 percent of its funding last spring, she said.

“This group of people has simply fallen through the cracks,” she said. “Personally, my predictions are frightening.”

Khaydarova, the head of the Network of Women Living with HIV, said she understands that the American administration must address its own problems, but hopes that political leaders realize the impact of the programs that were cut.

“Every cent or dollar that they send, they’re saving someone’s life, even if they don’t know where Tajikistan is,” she said.