For many Basotho, as Lesotho inhabitants are called, especially those living with HIV or working on the frontlines of prevention and treatment, these words felt like a sentence not just of neglect, but of abandonment. HIV/AIDS is one of the country’s most serious public health challenges, threatening not only the health of Basotho but also the country’s overall development. According to UNAIDS, by 2016 Lesotho had the second-highest HIV prevalence rate in the world, with approximately 25 percent of adults living with the virus. Over 240,000 Basotho rely on antiretroviral therapy (ART), and HIV and tuberculosis (TB) remain the leading causes of death. According to a 2022 UNAIDS report, more than one in five people aged 15 to 49 are HIV positive.

It had been clear that Trump’s presidency would disrupt the health system. Organizations that received funding from USAID were told to stop work immediately. Funds stopped arriving; soon, organizations could no longer pay rent, and their offices were locked by landlords. By February, 1,500 HIV counselors — 60 percent of the total number — had lost their jobs. Counselors conduct HIV testing and prepare those who test positive to take medication; they also distribute self-test kits to those who prefer to test privately. They often positioned themselves in busy areas so that people could easily access their services.

“We had people who were ready to come back to work the following day, but everything had to stop. I had to call each of the workers and break the news to them so they would not come to work the next day,” said Thakane Kotelo, the executive director of Phelisanang Bophelong, an organization focused on HIV prevention and treatment, which ran drop-in centers in the districts with the highest HIV rates, Leribe and Maseru. These centers were forced to shut.

The numbers only a few months after the cuts were staggering. USAID funding to Lesotho was slashed by 93 percent, while support from the U.S. Centers for Disease Control and Prevention (CDC) dropped by 6 percent. As a result, the aid Lesotho received from the U.S. plummeted from 1.4 billion Lesotho maloti to just M600 million ($77.8 million to $33.3 million).

Before Trump took office, Lesotho was on its way to overcoming HIV. The massive USAID budget cuts, and the uncertainty around the resumption of some funding, endanger decades of hard-won gains.