The women of No Sex for Fish are survivors — but their survival is precarious

Alice Akinyi (left, manus connected hip) and Justine Adhiambo Obura, members of nan No Sex For Fish group, guidelines adjacent to Alice's sportfishing vessel astatine Nduru Beach. It's 1 of nan fewer boats that person weathered nan storms and floods that person beset nan area since 2020. Julia Gunther for NPR hide caption

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Julia Gunther for NPR

"Our members are surviving pinch grace," says Justine Adhiambo Obura, nan chairperson of No Sex for Fish.

She's talking astir a cooperative of 20 women who did nan unthinkable. They are fishmongers from nan colony of Nduru Beach successful Kenya who said nary to fishermen who demanded: Give maine sex, and I'll make judge you get food to sell.

With nan support of various charities and programs, these women yet sewage their ain boats — and hired men to food for them successful Lake Victoria. The sanction of their group is simply a testament to their success.

But successful nan twelvemonth 2025, their endurance is precarious. The No Sex for Fish women are coping pinch nan bequest of disastrous floods that person virtually destroyed their colony and disrupted nan sportfishing business. And now they're facing caller fears astir their health.

Starting successful 2020, floods devastated nan colony of Nduru Beach, ruining nan mud-walled homes. Virtually everyone left. Some residents recovered lodging successful impermanent shelters group up on nan roadworthy starring to nan village. Julia Gunther for NPR hide caption

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Julia Gunther for NPR

Eleven of these women are HIV positive. Even arsenic their lives were upended by nan floods, they could count connected getting a free proviso of nan anti-retroviral narcotics they request to suppress nan microorganism and enactment patient — supplied by nan U.S.

But successful nan aftermath of nan Trump Administration's melodramatic assistance cutbacks, nan women opportunity they are seeing changes that make them anxious astir nan early — contempt U.S. assurances that nan proviso of narcotics will not beryllium interrupted.

Alice Akinyi, a No Sex For Fish member, waits to return a vessel to Nduru Beach to get nan latest drawback from nan fishermen to waste — roads were damaged by past floods truthful it's difficult to get to nan statement these days. She's 1 of only 2 members whose sportfishing boats are still functioning. The little half of nan location down her — nan area that's darker — was underwater during nan highest of nan flooding. The building is nary longer habitable. Julia Gunther for NPR hide caption

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Julia Gunther for NPR

A azygous mom's story

Rebbeccah Atieno is simply a No Sex for Fish personnel who is HIV positive. A azygous mom pinch six kids, she mislaid her location successful Nduru Beach to nan floods and now lives successful a location she had temporarily borrowed from a chap villager who was not affected by nan flood waters. But that neighbour expects her to move retired from nan location successful August and find her ain place.

Their erstwhile colony is now much for illustration an island, trim disconnected by nan flood waters. But Atieno still returns — either by hiring a vessel for $1 aliases wading done heavy h2o — to meet fishermen who usage 1 of nan No Sex group's 2 surviving boats and get a drawback she tin waste to gain money for nutrient and schoolhouse fees. 

While scaling a portion of tilapia pinch a blunt knife, she shares her worries.

Rebbeccah Atieno, a No Sex For Fish member, scales and courage nan food she bought from chap personnel Alice Akinyi astatine Nduru Beach, getting them fresh to sell. Julia Gunther for NPR hide caption

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Julia Gunther for NPR

She says that up until this twelvemonth she thought her awesome struggle would beryllium "the displacement from my home" because of nan flooding — and earning a living.

Now she has an further worry: Will she beryllium capable to get nan antiretroviral narcotics she needs to suppress nan HIV microorganism and enactment healthy?

"They utilized to springiness maine ARVs of up to 6 months but that has presently reduced to only 1 month," she says, referring to nan session that distributes nan drugs. It's an hour's locomotion each way, and now she must make much predominant trips — an further hardship successful nan difficult life of a moving azygous mother.

"We are frightened of what nan early holds," she says.

Rebbeccah Atieno (left) sits wrong her existent home, on pinch No Sex For Fish chairwoman Justine Adhiambo Obura and chap personnel Naomy Akoth. Julia Gunther for NPR hide caption

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Julia Gunther for NPR

So what did hap exactly? There are conflicting narratives.

The Trump management has many times said that nan proviso of life-saving narcotics would not beryllium affected by nan melodramatic simplification successful overseas aid.

But according to Dr. Fredrick Oluoch, nan head of nationalist wellness successful Kisumu County, wherever Otieno lives, nan U.S. cutbacks person caused interruptions successful nan proviso concatenation that gets narcotics into nan hands of those who request them.

It's a analyzable situation, explains a root who antecedently worked for PEPFAR, nan U.S. agency that targets HIV prevention and who said connected nan information of anonymity "to debar master aliases organization pushback that could forestall maine from speaking further."

The root said that a number of USAID contracts successful Kenya and elsewhere that covered anti-retroviral medications were halted and "took a while to restart."

What's more, immoderate clinics relied connected U.S.-funded programs to get nan narcotics to nan clinics wherever they are handed out. And nan authorities has stated that immoderate 41,000 wellness workers mislaid their U.S.-funded jobs successful nan aftermath of nan assistance cutback.

"The expertise to entree and present HIV medications was interrupted owed to session closures, firing tens of thousands of wellness attraction workers, and interruptions successful proviso concatenation delivery," nan root says.

The authorities has pledged to proceed nan distribution of these captious drugs, has since rehired galore of nan group who mislaid their jobs and has urged nan nationalist not to beryllium afraid. But it has not provided a afloat mentation of really patients will again beryllium capable to get a larger proviso of narcotics astatine 1 visit.

So moreover though location does not look to beryllium a shortage of anti-retroviral narcotics successful Kenya astatine this time, location is tremendous uncertainty, nan root says. As a result, immoderate clinics are hoarding nan narcotics they do have. This hoarding whitethorn besides bespeak nan mindset successful Kenya of a fewer years ago, erstwhile location was an existent shortage of anti-HIV drugs.

"People are telling maine that they're moving toward solutions," nan erstwhile PEPFAR worker said. "But if you're nan female who is simply a time costs earner and person to fig retired a measurement to spell each 2 weeks to get your attraction erstwhile you were going each six months, I'm judge it's upsetting and disturbing."

"There is simply a batch of anxiety, stress, slump among moreover nan HIV patients because they don't cognize nan future," says Oluoch. "They don't cognize whether they are going to get their medication."

Erick Okioma, an advocator for group pinch HIV, believes nan Kenyan authorities should reside immoderate gaps successful backing for HIV services caused by U.S. assistance cuts. Julia Gunther for NPR hide caption

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Julia Gunther for NPR

In consequence to an enquiry from NPR, a U.S. State Department spokesperson noted that "PEPFAR-funded programs that present HIV attraction and curen aliases prevention of mother to kid transmission services are operational for a mostly [of] beneficiaries.

"All different PEPFAR-funded services, including those provided by different agencies, are presently being reviewed for appraisal of programmatic efficiencies and consistency pinch United States overseas policy. PEPFAR, for illustration each assistance programs, should beryllium reduced complete clip if it achieves its mission. We are enhancing work transportation ratio and advancing PEPFAR partner countries toward self-reliance."

Erick Okioma, an HIV activistic and nan squad leader for nan Nelson Mandela TB, HIV Information organization, has been surviving pinch HIV for 20 years, believes nan cuts are a wake-up telephone to nan government.

"I americium decidedly worried because nan value of services is going to spell down. I tin opportunity that unless thing is done, we mightiness spell backmost galore years. Many years back," he says, referring to nan not-so-distant past. According to nan Ministry of Health, since 2010, Kenya has reduced caller HIV infections by much than 67%, from 101,000 cases successful 2010 to 16,752 infections successful 2024.

Haunted by a member's death

The women of No Sex for Fish cognize each excessively good really vulnerable HIV tin beryllium without preventive pills.

Rose Atieno Abongo, a mother of six who was HIV positive, died past October — earlier nan assistance upheaval of 2025 worries. Yet her decease is simply a reminder of really captious nan anti-HIV medications are.

Jack Len'go holds a photograph of his wife, Rose Atieno Abongo, who was a personnel of nan No Sex for Fish group. The photograph was taken successful 2019, erstwhile an NPR squad first reported connected this story. Rose died successful October 2024 of complications from HIV/AIDS. Len'go says she'd stopped taking her preventive narcotics because she was not getting due nutrition and nan pills were making her sick. Rose is buried adjacent to their home. Julia Gunther for NPR hide caption

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Julia Gunther for NPR

Her husband, Jack, says that nan family couldn't spend decent meals arsenic their income from trading food disappeared. He says Rose would sometimes vomit aft taking her drugs, So eventually, she stopped taking nan antiretrovirals. She gave up connected life, he says. She developed respiratory problems and a kidney infection, he says, and died of AIDS.

Jack is HIV affirmative arsenic well. "I person besides been taking my narcotics from wellness center," he says — that's nan Nyang'ande Sub-County Hospital. But he worries: Will clinics tally retired of pills? He has a teenage girl who is besides HIV positive. She keeps asking really agelong location will beryllium medicine for her and her dad.

"I person been trying my champion to guarantee nan kid that each will beryllium good but it is not easy. The fearfulness and worry is real," he says.

Naomy Akoth, who's 42, besides has fears astir erstwhile and really she will get her adjacent dose of ARV drugs.

Naomy Akoth must locomotion 40 minutes each measurement to get her proviso of HIV preventive drugs. Since nan U.S. assistance cuts nan session is distributing less pills astatine each visit, causing her to worry. Julia Gunther for NPR hide caption

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Julia Gunther for NPR

Like astir of nan HIV affirmative women from nan No Sex for Fish group, she picks up her narcotics astatine Nyang'ande infirmary — a 40-minute locomotion each measurement from nan impermanent lodging she recovered aft being displaced by nan floods.

Adding to her worries is nan trouble earning money to attraction for her 7 children. With nan sportfishing vessel that she'd erstwhile had now gone, she says, "My mini edifice business hardly makes 3 dollars successful a day," she says. And she worries that someday she will person to salary for nan HIV medications — though astatine this clip nan authorities has pledged to proceed distributing free pills.

"It is our dream that nan authorities will do thing to avert a crisis," she says.

Akoth contracted nan illness aft her hubby died successful 2002 and, pressured by section contented to wed again truthful a man could return attraction of her family, she wed a fisherman who was HIV positive.

It is simply a determination she regrets but she says location was thing overmuch she could person done to debar this fate. She has since separated from her husband.

Dr. Theresa Opiyo of Nyang'ande Sub-County Hospital, Kisumu, says that patients pinch HIV now request counseling to header pinch their fears that nan proviso of narcotics to suppress nan microorganism mightiness beryllium affected by U.S. assistance cuts. So acold nan effect has been that patients get less pills erstwhile they sojourn — possibly a proviso for 1 period alternatively than for half a year. Julia Gunther for NPR hide caption

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Julia Gunther for NPR

Theresa Opiyo, a expert astatine nan Nyang'ande wellness installation who supports HIV patients, says she is now counseling patients who are worried astir nan future. "The withdrawal of support has had a important antagonistic effect and has caused accent and unanswered questions," says Opiyo. She adds that she excessively is emotion accent from each nan uncertainties.

And it's not conscionable nan distribution of medicine that's connected her mind. Opiyo says that acquisition programs aimed astatine educating nan nationalist astir HIV transmission person been put connected clasp owed to assistance cuts. "Through nan program, we were capable to forestall nan dispersed of HIV among adolescents," she says. "The effect was immense because it besides helped trim mother-to-child transmission."

Cash assistance from array banking

Justine Obura, nan chairperson of nan No Sex For Fish Group, says nan group members are trying to support each other.

"We person besides been capable to support a array banking level that enables america to prevention and share," she says.

No Sex For Fish personnel Naomy Akoth makes notes during a "table banking" session. Members lend to a excavation of money; those successful request tin inquire for a loan. Julia Gunther for NPR hide caption

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Julia Gunther for NPR

"Table banking" is nan word for an informal savings association. Members who are capable to gain money — from trading fish, from increasing vegetables — lend regularly. Members who request rate tin inquire for a indebtedness pinch nan anticipation that they'll yet repay it. Sometimes nan petition is for rate to screen nan costs of a cab to get to nan session wherever they prime up their antiretroviral drugs.

They meet astatine Justine Obura's home. After nan floods of 2020 wiped retired overmuch of their village, she utilized her savings to bargain onshore astir 5 miles from Nduru Beach, wherever she built a location and now raises vegetables to gain income.

Alice Akinyi astatine Justine Obura's location conscionable earlier a Sunday "table banking" session. Julia Gunther for NPR hide caption

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Julia Gunther for NPR

Alice Akinyi Amonde is 1 of 2 members who still has a functioning boat. She herself is not HIV affirmative but says she and others connection some civilized and financial support erstwhile possible, paying for proscription to scope a session that will supply nan narcotics they need.

But she admits that her ain financial prospects are acold from secure. "The income is debased because nan drawback keeps dwindling," says Amonde.

The women of No Sex for Fish stitchery for a Sunday "table banking" convention to cod contributions and measure requests for loans. They're gathering astatine Justine Obura's home. Julia Gunther for NPR hide caption

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Julia Gunther for NPR

In spite of nan uncertainty they face, these women are still bold planners. Obura says they dream to get thief from a philanthropist to commencement farming atom and for different cultivation endeavors.

Yet it tin beryllium difficult to clasp connected to hope.

"We are surviving a regular nightmare," says Rebbeccah Atieno. "Hope is diminishing each time for our members. But we are still holding on, praying that nan floods will recede and nan uninterrupted proviso of captious life-saving narcotics will resume."

Viola Kosome is simply a Kenyan journalist. NPR editor Marc Silver contributed reporting to this story.