"Our members are surviving with grace," says Justine Adhiambo Obura, the chairperson of No Sex for Fish.
She's talking about a cooperative of 20 women who did the unthinkable. They are fishmongers from the village of Nduru Beach in Kenya who said no to fishermen who demanded: Give me sex, and I'll make sure you get fish to sell.
With the support of various charities and programs, these women eventually got their own boats — and hired men to fish for them in Lake Victoria. The name of their group is a testament to their success.
But in the year 2025, their survival is precarious. The No Sex for Fish women are coping with the legacy of disastrous floods that have virtually destroyed their village and disrupted the fishing business. And now they're facing new fears about their health.
Eleven of these women are HIV positive. Even as their lives were upended by the floods, they could count on getting a free supply of the anti-retroviral drugs they need to suppress the virus and stay healthy — supplied by the U.S.
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But in the wake of the Trump Administration's dramatic aid cutbacks, the women say they are seeing changes that make them anxious about the future — despite U.S. assurances that the supply of drugs will not be interrupted.
A single mom's story
Rebbeccah Atieno is a No Sex for Fish member who is HIV positive. A single mom with six kids, she lost her home in Nduru Beach to the floods and now lives in a house she had temporarily borrowed from a fellow villager who was not affected by the flood waters. But that neighbor expects her to move out from the house in August and find her own place.
Their former village is now more like an island, cut off by the flood waters. But Atieno still returns — either by hiring a boat for $1 or wading through deep water — to meet fishermen who use one of the No Sex group's two surviving boats and obtain a catch she can sell to earn money for food and school fees.
While scaling a piece of tilapia with a blunt knife, she shares her worries.
She says that up until this year she thought her major struggle would be "the displacement from my home" because of the flooding — and earning a living.
Now she has an additional worry: Will she be able to get the antiretroviral drugs she needs to suppress the HIV virus and stay healthy?
"They used to give me ARVs of up to 6 months but that has currently reduced to only one month," she says, referring to the clinic that distributes the drugs. It's an hour's walk each way, and now she must make more frequent trips — an additional hardship in the hard life of a working single mother.
"We are scared of what the future holds," she says.
So what did happen exactly? There are conflicting narratives.
The Trump administration has repeatedly said that the supply of life-saving drugs would not be affected by the dramatic reduction in foreign aid.
But according to Dr. Fredrick Oluoch, the director of public health in Kisumu County, where Otieno lives, the U.S. cutbacks have caused interruptions in the supply chain that gets drugs into the hands of those who need them.
It's a complicated situation, explains a source who previously worked for PEPFAR, the U.S. agency that targets HIV prevention and who spoke on the condition of anonymity "to avoid professional or institutional pushback that could prevent me from speaking further."
The source said that a number of USAID contracts in Kenya and elsewhere that covered anti-retroviral medications were halted and "took a while to restart."
What's more, some clinics relied on U.S.-funded programs to get the drugs to the clinics where they are handed out. And the government has stated that some 41,000 health workers lost their U.S.-funded jobs in the wake of the aid cutback.
"The ability to access and deliver HIV medications was interrupted due to clinic closures, firing tens of thousands of health care workers, and interruptions in supply chain delivery," the source says.
The government has pledged to continue the distribution of these vital drugs, has since rehired many of the people who lost their jobs and has urged the public not to be afraid. But it has not provided a full explanation of how patients will again be able to get a larger supply of drugs at one visit.
So even though there does not appear to be a shortage of anti-retroviral drugs in Kenya at this time, there is tremendous uncertainty, the source says. As a result, some clinics are hoarding the drugs they do have. This hoarding may also reflect the mindset in Kenya of a few years ago, when there was an actual shortage of anti-HIV drugs.
"People are telling me that they're moving toward solutions," the former PEPFAR employee said. "But if you're the woman who is a day wage earner and have to figure out a way to go every two weeks to get your care when you were going every six months, I'm sure it's upsetting and disturbing."
"There is a lot of anxiety, stress, depression among even the HIV patients because they don't know the future," says Oluoch. "They don't know whether they are going to get their medication."
In response to an inquiry from NPR, a U.S. State Department spokesperson noted that "PEPFAR-funded programs that deliver HIV care and treatment or prevention of mother to child transmission services are operational for a majority [of] beneficiaries.
"All other PEPFAR-funded services, including those provided by other agencies, are currently being reviewed for assessment of programmatic efficiencies and consistency with United States foreign policy. PEPFAR, like all assistance programs, should be reduced over time if it achieves its mission. We are enhancing service delivery efficiency and advancing PEPFAR partner countries toward self-reliance."
Erick Okioma, an HIV activist and the team leader for the Nelson Mandela TB, HIV Information organization, has been living with HIV for 20 years, believes the cuts are a wake-up call to the government.
"I am definitely worried because the quality of services is going to go down. I can say that unless something is done, we might go back many years. Many years back," he says, referring to the not-so-distant past. According to the Ministry of Health, since 2010, Kenya has reduced new HIV infections by more than 67%, from 101,000 cases in 2010 to 16,752 infections in 2024.
Haunted by a member's death
The women of No Sex for Fish know all too well how dangerous HIV can be without preventive pills.
Rose Atieno Abongo, a mother of six who was HIV positive, died last October — before the aid upheaval of 2025 worries. Yet her death is a reminder of how critical the anti-HIV medications are.
Her husband, Jack, says that the family couldn't afford decent meals as their income from selling fish disappeared. He says Rose would sometimes vomit after taking her drugs, So eventually, she stopped taking the antiretrovirals. She gave up on life, he says. She developed respiratory problems and a kidney infection, he says, and died of AIDS.
Jack is HIV positive as well. "I have also been taking my drugs from health center," he says — that's the Nyang'ande Sub-County Hospital. But he worries: Will clinics run out of pills? He has a teenage daughter who is also HIV positive. She keeps asking how long there will be medication for her and her dad.
"I have been trying my best to assure the child that all will be well but it is not easy. The fear and anxiety is real," he says.
Naomy Akoth, who's 42, also has fears about when and how she will get her next dose of ARV drugs.
Like most of the HIV positive women from the No Sex for Fish group, she picks up her drugs at Nyang'ande hospital — a 40-minute walk each way from the temporary housing she found after being displaced by the floods.
Adding to her worries is the difficulty earning money to care for her seven children. With the fishing boat that she'd once had now gone, she says, "My small hotel business barely makes three dollars in a day," she says. And she worries that someday she will have to pay for the HIV medications — although at this time the government has pledged to continue distributing free pills.
"It is our prayer that the government will do something to avert a crisis," she says.
Akoth contracted the disease after her husband died in 2002 and, pressured by local tradition to marry again so a man could take care of her family, she wed a fisherman who was HIV positive.
It is a decision she regrets but she says there was nothing much she could have done to avoid this fate. She has since separated from her husband.
Theresa Opiyo, a doctor at the Nyang'ande health facility who supports HIV patients, says she is now counseling patients who are worried about the future. "The withdrawal of support has had a significant negative impact and has caused stress and unanswered questions," says Opiyo. She adds that she too is feeling stress from all the uncertainties.
And it's not just the distribution of medication that's on her mind. Opiyo says that educational programs aimed at educating the public about HIV transmission have been put on hold due to aid cuts. "Through the program, we were able to prevent the spread of HIV among adolescents," she says. "The impact was huge because it also helped reduce mother-to-child transmission."
Cash aid from table banking
Justine Obura, the chairperson of the No Sex For Fish Group, says the group members are trying to support each other.
"We have also been able to maintain a table banking platform that enables us to save and share," she says.
"Table banking" is the term for an informal savings association. Members who are able to earn money — from selling fish, from growing vegetables — contribute regularly. Members who need cash can ask for a loan with the expectation that they'll eventually repay it. Sometimes the request is for cash to cover the cost of a cab to get to the clinic where they pick up their antiretroviral drugs.
They meet at Justine Obura's home. After the floods of 2020 wiped out much of their village, she used her savings to buy land about 5 miles from Nduru Beach, where she built a house and now raises vegetables to earn income.
Alice Akinyi Amonde is one of two members who still has a functioning boat. She herself is not HIV positive but says she and others offer both moral and financial support when possible, paying for transportation to reach a clinic that will provide the drugs they need.
But she admits that her own financial prospects are far from secure. "The income is low because the catch keeps dwindling," says Amonde.
In spite of the uncertainty they face, these women are still bold planners. Obura says they hope to get help from a donor to start farming rice and for other agricultural endeavors.
Yet it can be hard to hold on to hope.
"We are living a daily nightmare," says Rebbeccah Atieno. "Hope is diminishing every day for our members. But we are still holding on, praying that the floods will recede and the uninterrupted supply of vital life-saving drugs will resume."
Viola Kosome is a Kenyan journalist. See more of photojournalist Julia Gunther's work on her website or follow her on Instagram: @juliagunther_photography.
NPR editor Marc Silver contributed reporting to this story.
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