When donor funding was pulled back, the work didn’t stop. Neither did Lilian and Carolyne.

For years, Carolyne Akello and Lilian Tutegyereize have been essential to Uganda’s HIV response, working hand-in-hand with the Ministry of Health to introduce new prevention products, train healthcare providers, and translate research into real-world access. Most recently, they served as technical leaders on the USAID-funded MOSAIC project, which was accelerating new HIV prevention product introduction in 10 countries in Africa, including Uganda. But when foreign assistance shifted and the MOSAIC project was terminated, they didn’t walk away. They doubled down.

What does your day-to-day look like now? How are you continuing to support the Ministry or your colleagues in this moment?

Lilian: The day-to-day is not structured, there is no workplan, Our day is now dictated by the ministry, advocates who invite us to meetings. We continue to support all actors in the HIV response, we continue to provide technical assistance that the government requires for new product introductions.

Carolyne: We are so passionate about what we do. It has been natural for us to stay in this space because we have been working in this space for so long, continuing to do it despite the funding disappearing.

When the MOSAIC project ended, what made you stay engaged instead of walking away?

Carolyne:  For me, it’s personal and it’s my passion. I used to work on HIV prevention clinical trials like the VOICE, ASPIRE, and HPTN-084 studies. Moving into product introduction meant I could help make sure the research I believed in actually reached the people who needed it. 

Lilian:  Even when MOSAIC ended, the HIV prevention response did not end in the country. There was a crisis in the country, how could we walk away?

What changed for you—practically and emotionally—when foreign assistance started to pull back?

Carolyne: It was disheartening to witness the progress made being reversed.

Lilian: Each and every household in Uganda has either been affected or infected by HIV. If there is anything we can do to prevent HIV in this country, we will continue doing it—whether there’s funding or not.

What does real “country leadership” mean to you—not in donor terms, but in your own experience?

Lilian: When PEPFAR came in, they came in with their own structures. They came with drop-in centers, community peers, health care providers, reporting systems. All the pillars of HIV response were affiliated with PEPFAR. When funding disruptions came, Uganda entered into a crisis. We had drugs locked in warehouses and no one to distribute them. 

Carolyne:  The government is stepping up. There has been a shift towards service integration and domestic resource mobilization. HIV prevention is now being absorbed into the primary healthcare system. It is going slow, but it’s happening. 

If you could speak directly to donors or global actors right now, what would you want them to understand about what’s happening on the ground?

Carolyne: If you are to come to help us, help us within our existing systems, do not superimpose your systems on us. Allow our system to flourish, allow us to make sure our healthcare systems are sustainable long term.

Lilian: Other donors have stepped in, even small ones. We are on the road to recovery. The Ministry of Health is taking the lead. However slow, it is happening and soon it will flourish.

What advice would you give to someone else who finds themselves in a moment of transition or uncertainty like this?

Lilian: What has cushioned us is that we had strong relationships with stakeholders across the board. So we knew each other and could continue to work together. We did not feel emptiness or loss because we had each other.

Take ownership. Prepare. Whenever you are called upon, avail yourself. You can find a way to keep busy and be part of what is happening. Other opportunities find you.

Put people first, then funding, and you will find your way.

📸 Photo Credit: Benjamin Eveslage