‘Everything Is Dramatic Here’
Lesotho mothers fear for their babies as US cuts funding threaten to undo two decades of progress preventing mother-to-child transmission, putting countless new-borns at risk in a country that had come close to eliminating such infections – despite having the world’s second highest HIV prevalence rate. The cuts have blindsided Lesotho’s politicians and left them scrambling with no clear solutions or concrete answers. This investigation was produced in partnership with the Pulitzer Centre.
PASCALINAH KABI
“I would ask Trump how he feels knowing HIV is so dangerous, especially when he’s in a position to help people, particularly a small country like Lesotho. I am scared for people living with HIV, because in the end, they will die if they don’t take their ARVs.”
Twenty-year-old Matšeliso Nthunya’s voice is small but firm as she speaks, seated on a brown bench with a thick blue fleece wrapped around her waist in a rural clinic in Lesotho.
Nthunya is HIV-negative – alive and healthy because, USAID funding ensured her HIV – positive mother delivered her safely in 2005 without passing on the virus. Now, on June 27, 2025, she is at Nazareth Health Centre in Maseru, Lesotho’s capital.
She sits inside a yellow-walled room where the cold winter air battles the warmth of a small black-and-red paraffin heater.
She is one of eight pregnant women, aged between 17 and 33, who have come for their monthly check-up and health talk. The expectant mothers sit in a semicircle around midwife Mphonyane Thetso, who is stationed behind a sunlit window.
A grey steel table, wrapped in peeling white-and-grey contact paper, separates Thetso from the women, who listen intently as she urges them to deliver their babies at the centre or St Joseph’s Hospital in Roma. There, she says, mothers and their babies have a fighting chance not to contract HIV should complications arise.
US aid cut leaves mothers at risk
While Nthunya’s desire is to put Trump on the spot and appeal to his humanity, the reality is that his decision in January 2025 to stop the US President’s Emergency Fund for Aids Relief (PEPFAR) has left Lesotho’s vulnerable with little hope and a shrinking safety net.
For two decades, PEPFAR has underwritten nearly every layer of Lesotho’s HIV response – from salaries and lab testing to antiretroviral and mobile outreach. At M1.3 billion a year, PEPFAR accounted for 66.5 percent of the M1.9 billion budget for 2024/25, according to Lesotho’s ministry of health. This is significant in a country where one in five people are living with HIV.
Political leaders in Lesotho were shocked by the news, caught off guard and unprepared. Some relief was announced in March 2025 when the US agreed to resume 28 percent of the PEPFAR funding for a narrow focus – primarily medicine distribution and does not include the Prevention of Mother-to-Child Transmission (PMTCT) programme.
In a country that has the world’s second-highest HIV prevalence, according to the World Health Organization’s August 2023 Disease Outlook report this is devastating.
Outside the room where Thetso and the pregnant women are gathered, the health centre, the yard is quiet, dotted with office blocks and staff residences. One office bears a sign that feels heavier now than ever: “Nazareth Health Centre was funded by the American people through the Millennium Challenge Account, September 2013.”
The irony is impossible to ignore. In April and May 2025, pregnant women arrived for their mandatory HIV tests and go untested. Over 800 of the 1 500 HIV counsellors and nurses who once guided women through testing and helped them protect themselves and their babies have been dismissed – casualties of the US foreign aid freeze.
For a brief window in June, a student intern stepped in to provide HIV counselling and testing, allowing a handful of women, including Nthunya, to be tested. But from July, that service disappeared once again, as the intern’s last day at Nazareth Health Centre was June 27.
Thetso looks straight into this journalist’s eyes and said: “Everything is dramatic here.”
The drama unfolding right before Thetso’s eyes keeps her awake at night because she knows that some of these women – or others who delivered between April and May 2025 – may have unknowingly passed HIV to their babies.
The consequences of these funding cuts are already visible on the ground.
“We have records showing that some women delivered their babies in April and May 2025 with invalid (inconclusive) HIV status because they were not retested after we lost our HIV counsellor,” Thetso said.
She explained: “Sometimes a pregnant woman tests HIV-negative at her first visit. Then, when she comes back at 36 weeks for a re-test, she tests HIV-positive. A woman can give birth HIV-positive without knowing it if she wasn’t retested.
But if she tests positive, we can still prevent mother-to-child transmission with ART and PrEP. You can’t give PrEP to someone if you don’t know their HIV status.”
The concern echoed at the highest levels of Lesotho’s health system. But there are no concrete solutions. The Ministry of Health’s HIV/Aids Manager, Dr Tapiwa Tarumbiswa, told parliament on May 20, that “HIV-unsuppressed mothers are more likely to infect their children during pregnancy, birth, and breastfeeding.”
In an interview on July 8, the Ministry of Health’s Principal Secretary, ’Maneo Ntene, said the government was not yet in a position to publicly discuss efforts underway to address this funding shortfall.
“We are still working on the modalities of closing that gap,” Ntene said. “The Ministry of Health is not working alone on this; as we speak, I am driving to the Ministry of Public Service for discussions related to this issue.”
However, Dr Tlohang Letsie, a senior lecturer at the National University of Lesotho doesn’t mince his words. He warns that there is little hope of the “American fund to Lesotho” being restored, at least in the near future because Lesotho lacks minerals that the US can benefit directly from.
He indicated that the current US administration is motivated by a cost-benefit analysis, referencing countries like DRC and Rwanda.
“Another factor is that Lesotho seems to be hopeless in engaging the US. The country is simply not doing enough. It appears we are waiting for the divine intervention to blow some spirit of philanthropy into the Americans,” Dr Letsie said.
Mokhothu Makhalanyane serves as Chairperson of the Social Cluster Portfolio Committee in Lesotho.
In a separate interview on July 8, Makhalanyane said: “The Ministry of Health has quantified the actual cost of human and medical resources. The total impact is about M800 million, but we anticipate that this year the cost will be around M250 million.
As a result, parliament approved a contingency allocation of about M300 million for health to help address the impact of the US aid cuts.”
Meanwhile, this diplomatic inertia has life-or-death consequences. For Lesotho’s mothers-to-be, a test, a pill, a political decision made thousands of miles away can mean the difference between life and death – for themselves, and for the babies quietly growing inside them.
“Delayed HIV testing and diagnosis will result (in) increased AIDS-related mortality due to individuals presenting late with advanced HIV disease,” Dr Tarumbiswa said.
Could China close the funding gap?
Dr Tlohang Letsie believes China could step in to help fill the funding gap left by the US cuts.
“China has over the years appeared to be an alternative to the West in many regards. It can easily be persuaded to close the gap left by the Americans,” Dr Letsie said.
He pointed to China’s role during the Covid-19 pandemic as an example.
“We have seen during the Covid-19 era that it can play that role. However, it would take some time to shift from the US strategies to the new Chinese strategies.”
In September 2020, China sent a medical team to Lesotho to support its Covid-19 response. By August 2021, it had donated over 200 000 doses of Sinopharm vaccines to the country.
In his capacity as Health Committee Chair and head of the Network of African Parliamentary Committees on Health (NEAPACOH) – a continental parliamentary bloc on health – Makhalanyane said most African countries, including Lesotho, are exploring inward funding strategies.
“At a NEAPACOH meeting earlier, no one was talking about how to negotiate with America,” he said. “People were discussing how to utilise the resources we already have, how to avoid and eliminate waste, and how to increase domestic funding for health.”
Makhalanyane added that Lesotho’s Ministry of Health is preparing to table a health insurance strategy before Parliament. Once approved and legalised, it would reduce the government’s burden in subsidising health services. He noted that countries like South Africa, Zambia, Kenya, Tanzania, and Rwanda have adopted similar models.
Tears of gratitude
About 30 minutes after the group interview with the eight pregnant women, 20-year-old Nthunya sits again in her spot by the door.
“I am HIV-negative, and even my sibling born in 2016 is HIV-negative,” Nthunya said softly.
She never asked her mother if she was HIV-positive when she gave birth to her, but in her heart, she is almost certain that was the case. She first learnt about her mother’s HIV status in 2016, the same year her younger sibling was born – another moment that deepened Nthunya’s respect and admiration for her mother, not only for loving her children but for protecting them from HIV.
Now nine months pregnant and HIV-negative herself, Nthunya says her mother’s experience has shaped her understanding of what it means to care for herself and her unborn child.
“I must take care of myself because I have seen from my mother that even if a parent is HIV-positive, a child born from that mother can be HIV-negative,” she says.
A little while later, tears spill down her oval cheeks when she is asked: knowing you are HIV-negative today because your HIV-positive mother made the decision to protect you, what would you say to her?
“I would say a lot of things. I would thank her for taking care of me, for the love she had for me to protect me from being infected at birth,” Nthunya said, her voice catching.
“I would say a lot of things – and cry.”
And with that, she breaks into tears of gratitude she can no longer hold back. But beneath the gratitude, a deep fear lingers in her heart – the fear that her mother might die from Aids, unable to access life-saving HIV medication due to President Trump’s decision to cut funding for HIV programmes in poor countries like Lesotho.
Nthunya firmly believes Trump made the wrong call.
“Does he realise how many lives are now at risk because he chose not to help us for his own reasons?” she asked.
“I don’t think Trump made the right decision, because many people are going to die. If he wanted to make cuts, he should have done it elsewhere, not here.”
The concern Nthunya feels echoes within Lesotho’s health system. Dr Tapiwa Tarumbiswa, the Ministry of Health’s HIV/Aids Manager, warns: “The impact of cutting treatment and care services is that, if we are not providing quality treatment and care, there’s the potential for an increase in Aids-related deaths.”
…halting Mentor Mother could reverse hard-won gains in stopping baby HIV
The PEPFAR cuts will undo two decades of progress preventing mother-to-child HIV transmission.
In 2001, when HIV-positive pregnant women across Africa struggled to access treatment to stay healthy and protect their unborn children, an organisation called mothers2mothers (m2m) was born.
“HIV transmission rates from mothers to their babies were alarmingly high – in some places as high as 40 percent – largely due to limited access to information, testing, and treatment,” said Mpolokeng Mohloai, Country Director for mothers2mothers Lesotho, in a June 20, interview with Uncensored News.
Many women, she explained, only learnt they were HIV-positive late in pregnancy, or not at all, missing crucial windows for intervention. But the introduction of the Mentor Mothers programme changed that story.
“The introduction of the Mentor Mothers programme was a game-changer. Mother-to-child transmission (MTCT) rates dropped dramatically in the communities where m2m worked.
“In 2023, we achieved virtual elimination of mother-to-child transmission of HIV among our enrolled clients for the 10th consecutive year, reaching a 0 percent transmission rate for the first time – a goal that has driven our work since our creation.”
Yet today, even m2m is feeling the weight of US foreign aid cuts. Mohloai said funding cuts from key donors like PEPFAR and USAID have directly impacted their ability to deliver services at scale.
Asked what would happen if their programme was scaled back or discontinued due to these funding cuts, Mohloai’s voice tightened.
“Scaling back or discontinuing the Mentor Mothers programme would risk undoing decades of progress in preventing mother-to-child transmission of HIV,” she warned.
“Without this trusted, community-based support, we would likely see an increase in infant HIV infections, decreased treatment adherence, and lower retention in care. Women would have fewer safe spaces to seek help, and overburdened health facilities may struggle to fill the gap. The human cost – especially for women and children – would be devastating.”
