Lesotho's HIV progress unravels as U.S. aid cuts close clinics

In Lesotho’s mountain villages, the first sign of Washington’s retrenchment is often a long walk for nothing. Mothers carrying babies on their backs have traveled for hours to reach clinics, only to find HIV testing no longer available and doors closed at centers that once anchored care for the country’s most vulnerable. Hlaoli Monyamane, a 32-year-old miner living with HIV, captured the fear spreading through communities: “Everyone who is HIV-positive in Lesotho is a dead man walking.”

The disruption began after President Donald Trump signed Executive Order 14169 on Jan. 20, 2025, freezing foreign aid and moving to slash overseas assistance and dismantle USAID. Six days later, the State Department said Secretary Marco Rubio had paused all U.S. foreign assistance funded by or through the State Department and USAID for review. Officials have said six-month bridge programs are meant to preserve lifesaving services such as testing, medication and prevention of mother-to-child transmission, but restarting programs on the ground takes time, and health workers in Lesotho say the result has been patchwork fixes, uncertainty and fear.

UNAIDS said on March 17 that some U.S.-funded HIV projects in Lesotho had received full activation notices, including an orphans-and-vulnerable-children program operating in all 10 districts, a DREAMS project in four districts and a treatment-and-care project in two districts. CDC-backed projects were also reactivated. But UNAIDS said the cuts had already caused major disruption, with significant staffing losses among health workers supported by PEPFAR funding. In practice, unpaid nurses and other workers have been left to rely on informal networks to reach isolated communities, while patients wait to see whether care will return in a stable form.

That instability threatens hard-won gains in one of the world’s most heavily affected countries. UNAIDS estimated that 262,000 people of all ages were living with HIV in Lesotho in 2024, including 6,000 children under 15, and adult prevalence among those ages 15 to 49 stood at 17.1 percent. The country has cut HIV incidence by 87 percent since 2010 and reduced AIDS-related deaths from 8,000 in 2010 to 4,000 in 2024, progress that helped push Lesotho toward 95-95-95 targets.

The U.S. role in that progress runs deep. CDC says it has worked in Lesotho since 2007 and helped implement electronic medical records in 195 PEPFAR-supported facilities, allowing automated reporting at 184 health facilities. PEPFAR says it has invested more than $100 billion globally since 2003, supported antiretroviral treatment for 20.6 million people as of Sept. 30, 2024, helped save 26 million lives and enabled 7.8 million babies to be born HIV-free. PEPFAR operates in 55 countries. In Lesotho, the question is no longer only whether aid resumes, but whether a health system built around American support can hold together long enough to keep treatment, trust and survival from unraveling.