When the adult in the room is gone: Trump’s budget cuts and global drug policy

The Trump administration’s slashing of foreign aid is already having a devastating impact on harm reduction and HIV services around the world. But the harmful effects extend far beyond that. Drugreporter interviewed key experts at the annual UN drugs meeting, the CND in Vienna, to provide a clear picture of the real impacts.

In its first three months, the Trump administration, under the direction of the Elon Musk-led Department of Government Efficiency (DOGE), cut around $54 billion in foreign aid contracts. Globally, 171,610 aid workers lost their jobs, including approximately 2,000 employees of the US Agency for International Development (USAID), which was the most affected.

“I feel ashamed to see that a country capable of doing so much good in the world is actively seeking to do so much harm,” John Walsh, the Director for Drug Policy and the Andes at the Washington Office on Latin America (WOLA), told us.

So far, many foundational global health efforts—such as treating malnutrition, preventing newborn and maternal mortality, and eliminating infectious diseases like HIV, malaria, tuberculosis, and polio—have been impacted, along with harm reduction programs.

According to Ann Fordham, the director of the International Drug Policy Consortium (IDPC), the impacts are devastating.

“USAID and PEPFAR funded harm reduction all over the world. Many people have already fallen off their HIV treatment, HIV prevention is going to be deprioritized, and there is going to be a very serious impact.“

The Trump administration also withdrew its contribution to the UNAIDS‘ budget, which accounted for 50% of the organisation.

“Cutting funding at this fragile moment is tantamount to cutting the future of so many people around the world,” said Zaved Mahmood, a Human Rights Officer from the UN Office of the High Commissioner for Human Rights (UNOHCHR).

The International Network of People who Use Drugs (INPUD) quickly launched a special survey to understand the impacts of these cuts on the ground.

“The first findings are really shocking,” says the newly appointed Executive Director of INPUD, Anton Basenko.

Seventy-six organizations responded to the questionnaire, with more than 60% being community-led organizations. For 25% of these NGOs, US funding was almost the only available funding source. The most affected programs were HIV testing, services for women who use drugs, legal and human rights support, and HIV treatment. The most disrupted programs were outreach and peer work.

“These two programs are the foundation of any further harm reduction work. If you cut these, you are dismantling the entire model,” said Basenko.

The cuts impact Africa the most, as the continent received the majority of US aid.

“A lot of our public healthcare clinics are directly funded by USAID, and we also have CDC- and PEPFAR-funded clinics,” explained Julie MacDonnell, a healthcare, human rights, and harm reduction consultant from South Africa. Cutting this funding will affect women’s access to sexual and reproductive healthcare services in rural areas, as they cannot access alternatives. “We are going to see a decline in healthcare and a rise in mother-to-child transmission of HIV.“

The health response in Eastern Europe and Central Asia is also affected, particularly HIV testing, care, and treatment.

“An important component that we always forget is the narrative shift,” Ganna Dovbakh, the Executive Director of the Eurasian Harm Reduction Association, told us. “Right-wing and populist governments now feel emboldened to speak out against LGBTQ people, people who use drugs, and other minorities to gain political support. It seems like the only reasonable adult in the room has disappeared.“

A sad example of this is our own country, Hungary. In March 2025, the far-right government of Viktor Orbán banned the annual Pride march, claiming it posed a threat to children’s well-being. Orbán argued that Hungary had previously been under pressure from the West not to take such action, but now that the “winds have changed,” it was time to act. His government also launched a new war on drugs, preparing for a major crackdown on civil society and free speech. They introduced a constitutional amendment banning not only “the use and distribution” of illicit drugs but also the so-called “promotion” of them. This Russian-style ban on “drug promotion” could lead to the repression of harm reduction and drug policy reform efforts, including Drugreporter itself.

According to Ann Fordham, the overdependence on US funding was not sustainable, but the speed at which the cuts happened made it impossible to fill the immediate gaps. Cutting development aid is visible in almost all other countries as well, though not as swiftly and ferociously as in the USA.

Maria-Goretti Loglo, the Africa Consultant for the IDPC, sees an opportunity in this crisis. If African governments collaborate, they could find solutions to fund the health sector. “This is a wake-up call for many African countries. If we could fight corruption in Africa, we wouldn’t even need aid programs to function effectively.“

“The criminalization of people who use drugs is extremely costly”, and perhaps European governments will realize that it diverts too many resources away from security spending, speculated Ganna Dovbakh.

“All our lives are filled with struggles, challenges, and living underground. This is not new to people who use drugs,” says Anton Basenko. “Maybe it is time for more aggressive advocacy and organization.“

We addressed two more pressing topics in the film. One is the Trump administration’s new war on drug cartels, designating them as terrorist organizations.

“If any US administration really wanted to put the drug cartels out of business, they should approach the idea of legal regulation—our lucrative market. This is not what Trump seems to have in mind,” explains John Walsh.

And lastly, there are also progresses to report:

At we finished filming and left the CND, a historic vote initiated an overdue review of the UN drug control “machinery.” The majority of member states voted to create a panel of independent experts to rethink the global drug control regime. The landmark resolution led by Colombia, established a multidisciplinary panel of 19 independent experts, acting in their personal capacity, to prepare a clear, specific, and actionable set of recommendations aimed at enhancing the implementation of the three drug conventions, as well as the obligation of all relevant international instruments, and the achievement of all international drug policy commitments’.

The scientific review of the coca leaf by the WHO is still ongoing, regardless of the US cutting WHO funding. David Choquehuanca Céspedes, Vice President of Bolivia, appeared before the CND crowd with coca leaves in his hand, explaining that the coca leaf is a gift to the Andean-Amazonian peoples. Hernan Vales, the Chief of the Indigenous Peoples and Minorities Section at the UN Human Rights Office, reaffirmed that including the coca leaf in Schedule 1 of the UN drug conventions was a historical error and that it should be completely removed. Hopefully, the WHO’s recommendation will reflect this very soon.

The video was financed by the Robert Carr Fund, via the Harm Reduction Consortium.

Reporter: Péter Sárosi
Video and article: István Gábor Takács