Kittinun Daramadhaj

It was next year, not 2025, that was meant to be the difficult one for the Rainbow Sky Association of Thailand. Officials with the President’s Emergency Plan for AIDS Relief had made it clear there was not likely to be anymore U.S. government support for the program after September.

Over more than a decade, those funds have helped transform RSAT from a community-led effort providing basic HIV services to marginalized communities to one of the premier organizations in the country. RSAT operates six different clinics across the country, drawing tens of thousands of people for HIV prevention services, to get tested and treated for a range of sexually transmitted infections and for mental health support.

Ahead of PEPFAR’s planned withdrawal, RSAT had been lobbying the Thai government to take over funding some of the services Washington currently pays for, including pre-exposure prophylaxis that can prevent infection. The organization was also asking for some basic policy changes that would make their clinics eligible to provide additional services and draw more domestic funds. And the officers were building up their savings in case they ran into any cash flow problems.

Kittinun Daramadhaj, RSAT’s president, said the organization was ready for the transition in September.

We were already aware that PEPFAR will end the funding at the end of 2025. We already know that. So we already prepare.

What he was not prepared for, though, was the Trump administration cutting off foreign aid in late January, including $20,000 RSAT was still expecting to receive this year. He was counting on that money to fund services for about half of their clients through September.

Daramadhaj runs a nightclub for a living, while working for RSAT on the side, and his flair for the dramatic emerges as he begins to recount all that has happened since receiving the order to stop PEPFAR-funded activities.  

We have to monitor day by day. I could not sleep at all because I had to consider how to sustain the service in the longer term. We started putting our own pocket money to replace the funds.

This was the money they had been setting aside to sustain them through any difficult periods next year.

It only took a few weeks before he realized he needed to convene his leadership team to start weighing what other options were available to them.

After a while, we thought our pocket money will be gone soon. We have to start thinking and come up with how to do the cost reduction. Should we stop PrEP? Should we stop the HIV testing? After brainstorming among the staff, we decided to maintain the services.

The only choice left was to let some staff members go.

Six staff had to leave the organization. There are also some staff who would like to resign, so in total, we lost 11 staff.

At the same time, he realized that they would need to draw more clients for the services that are actually paid for by the Thai government, including HIV testing and treatment efforts. If they could earn more revenue from these activities, it would help underwrite the services that PEPFAR was meant to be supporting.

But that means more work, including ramping up community outreach, for a reduced staff.

It’s a more extreme workload. Normally they work eight or 10 hours per day, but now they have to work harder. They have to reach more in the communities than in the past.

He understands it’s a risk. If the clinics are suddenly full with new clients, longstanding patients may no longer feel comfortable.

Because they are very crowded, people may feel stigmatization.

What choice does he have, he asks with mock exasperation.

This year we’ll just have to work hard.