When former U.S. President Donald Trump framed the U.S. Agency for International Development (USAID) as a wasteful bureaucracy and dissolved the agency in 2023, the policy change sent shockwaves through global development networks, eliminating 280,000 jobs worldwide. While mainstream coverage has centered on how the cuts disrupted services for millions of vulnerable people relying on U.S. foreign aid, one on-the-ground investigation from Nepal has uncovered a hidden, devastating consequence: dozens of out-of-work local aid workers, many from marginalized LGBTQ+ communities, have been forced to turn to sex work to avoid starvation.
In an interview with AP editor Mary Rajkumar, investigative reporter Kristen Gelineau — who spent months documenting the crisis on the ground in Nepal — explained why she chose to center this underreported story. Global headlines have been dominated by coverage of the cuts’ direct harm to aid recipients: children losing access to nutrition programs, communities facing shortages of life-saving medications, and public health initiatives collapsing. Most of the rare coverage of displaced workers has focused on the small share of U.S. citizens employed by USAID, who make up less than 10% of all workers put out of a job by the dissolution. The vast majority of displaced workers are local hires living in low-income, conflict-impacted nations where alternative employment opportunities are effectively non-existent. Gelineau set out to uncover what happened to these forgotten workers.
Her reporting took an unexpected turn while examining the impact of cuts across South Asia. When an HIV researcher in Nepal offhandedly mentioned that former employees of HIV prevention NGOs were now entering sex work to pay their bills, Gelineau launched a deeper inquiry that revealed the trend was far from an isolated case. Across Nepal, many LGBTQ+ former aid workers who once supported marginalized communities including sex workers now faced the same desperate choice: find work in an economy that refuses to hire them, or turn to survival sex work to feed themselves. Local health officials already warned that the shift could drive a new increase in HIV prevalence, undoing years of progress made by the very programs USAID once funded.
Gaining access to and the trust of these traumatized workers took months of careful, ethical reporting. Working with visual journalist Bram Janssen and local translator Tulsi Rauniyar, Gelineau built connections through existing networks in Nepal’s LGBTQ+ community, shared her track record of ethical coverage of marginalized groups, and initiated contact through text before moving to in-person conversations. Reporting focused on Kathmandu and Hetauda, where a large cohort of displaced aid workers had turned to sex work and agreed to share their stories. Every interview opened with detailed conversations about informed consent, with workers guaranteed the right to pause, end the conversation, or skip any questions that could cause re-traumatization. The reporting team even shadowed workers on night shifts along major highways to understand the full scope of the risks they face daily.
What struck Gelineau most during the reporting process was the extreme vulnerability of the workers, a danger that only became tangible after observing their working conditions first-hand. The remote, dark highway corridors where most solicit clients offer no protection, and workers are regularly surrounded by intoxicated groups of men who bargain aggressively before taking them to isolated locations in nearby jungles, industrial areas, or private residences. Nearly every worker interviewed reported experiencing sexual or physical assault on the job. Even encounters with police do not improve their safety: multiple workers reported assault at the hands of officers, leaving them more afraid of law enforcement than of their clients.
For all the extreme risk they take on, workers typically earn just $2 to $3 per client. But for openly transgender workers in particular, legal formal employment is effectively banned by social stigma and discrimination in Nepal. As workers repeatedly told Gelineau, the choice is non-negotiable: it is sex work, or starve.
In a statement following the dissolution of USAID, the U.S. State Department defended the Trump administration’s restructuring, claiming the changes had reinvigorated foreign assistance programs to prioritize efficiency, effectiveness, and global partnership. The department also noted that the U.S. spends more on global health and humanitarian assistance than any other nation. For the dozens of Nepali workers now pushed into dangerous survival sex work, and the 280,000 displaced workers globally, that restructuring has come at a devastating human cost that has yet to be fully counted.