In Lesotho and Eswatini, U.S. budget cuts threaten to wipe out years of progress against HIV
On 14 May, Temalangeni Dlamini, 20, traveled 10 kilometers from her rural home in southern Eswatini to the Matsanjeni Health Centre for the first check-up of her pregnancy, which was already 8 months along. Dlamini was hoping to give birth at the clinic, which required an evaluation beforehand. The procedure included an HIV test, and to her surprise, Dlamini was positive. The doctor immediately put her on antiretroviral (ARV) treatment, which would also protect her child from infection. The small, low-slung brick clinic has long received assistance from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), which paid for nurses, outreach workers, cellphones, and internet access, and provided transport for staff to make home visits. But in January, President Donald Trump’s administration began dismantling its main funder, the U.S. Agency for International Development (USAID), and scrapping thousands of grants and contracts.
For Dlamini’s family, the cuts hit home. In the past, the health center would have sent staff to her home after her diagnosis to test her two children and other relatives living nearby for HIV. If needed, everyone who tested positive would receive transport to the clinic, where they would receive treatment and then viral testing to make sure they were taking the drugs and had not developed resistance. This type of intensive follow-up is especially crucial for children, who depend on adults to take their medicines, and, if the virus is unchecked, become sick and die more quickly. Teens, being teens, often have difficulty taking daily pills.
Now the clinic could no longer afford the visit to Dlamini’s home. Gcebile Shongwe, a testing counselor at the clinic who had made many such trips, says she initially could not believe that PEPFAR’s support had ended. “I was so distressed,” she said. “I was shattered.” Eswatini, a small landlocked country formerly known as Swaziland that shares borders with South Africa and Mozambique, has long had the unfortunate distinction of having the world’s highest percentage of adults living with HIV. Second is Lesotho, another small nation 500 kilometers to the south that’s entirely surrounded by South Africa. But over the past 20 years, PEPFAR’s support has helped both sharply reduce new infections as well as illness in those living with the virus. Now, many fear they will become sad examples of the damage caused by the Trump administration’s sudden disruption in HIV/AIDS funding.
Both governments already pay for a large percentage of the drugs that have helped drive the progress and have pledged more help. But neither country is likely to make up for the tens of millions of dollars in support they appear to have lost. “We’re at the cusp of achieving epidemic control,” says Christopher Makwindi, who heads the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) office in Eswatini and has worked on the program there for 14 years. “I feel there’s going to be a reversal of all the gains.”
https://www.science.org/content/article/u-s-aid-helped-two-african-countries-rein-hiv-then-came-trump