MPONGWE, Zambia — Sweeping U.S. cuts to the President’s Emergency Plan for AIDS Relief, or PEPFAR, have triggered a collapse of HIV prevention and treatment services across Zambia, where hospitals are filling with dying patients, critical outreach programs have been eliminated, and the government faces an April 30 deadline to sign a minerals-tied aid agreement or lose all remaining U.S. HIV funding, according to The New York Times.
Saulo Kasekela, a 37-year-old security guard, died of AIDS on March 7 at a mission hospital in Mpongwe, in Zambia’s Copperbelt, the Times reported. A nurse set aside his chest X-ray after his body was wheeled out of the ward — a clouded smear of lungs devoured by tuberculosis, a hallmark of advanced, untreated HIV infection, according to the Times.
Of the eight patients in the ward that day, four had AIDS, the Times reported. A year ago in Mpongwe, there was one case like this each month, or maybe two — in January this year, there were 28 new cases; in February, 28 more; in March, seven more, as reported by the Times.
“It was like a military state of emergency,” said Dr. Suilanji Sivile, the national technical adviser to Zambia’s HIV program, as quoted by the Times.
The Zambian government went into emergency mode when PEPFAR funding was upended during the first month of the Trump administration, sending directives to provincial health offices to redeploy whatever staff remained to keep antiretroviral medication moving, the Times reported.
The government says most of the 1.3 million people who were on HIV treatment in January 2025 are still receiving their drugs, though the health ministry estimates 100,000 people stopped taking their medication in the upheaval, and 40,000 have yet to be re-engaged, according to the Times.
The scale of what has been cut is staggering, the Times reported. Dr. Lloyd Mulenga, who leads Zambia’s national HIV program, sat with his colleagues in early 2025 and made the painful decision of what services to eliminate.
Index testing — a labor-intensive system that traced the sexual contacts of people who tested positive and accounted for 70% of all infections identified each year — has been shut down entirely, the Times reported.
Pregnant women with HIV, previously tested three times over their pregnancy to detect medication failure, are now tested only once, according to the Times. Babies born to HIV-positive mothers are no longer tested until 6 weeks old, rather than within hours of birth when antiretroviral treatment can be started immediately, the Times reported.
Dedicated service centers for gay men and sex workers — communities facing heightened vulnerability to HIV — have been closed, as have the community distribution sites where antiretroviral drugs were once available discreetly in small market shops and churches. More than 100,000 Zambian men received free circumcisions annually under PEPFAR; that program has been canceled, the Times reported.
The human consequences of these cuts are already visible, the Times reported. At the Chipulukusu clinic in Ndola, Maureen Dhaka, who has HIV, gave birth on March 5.
Her baby was given no HIV prophylaxis for nearly two full days after birth, and no one tested him for HIV despite his mother living with the virus, according to the Times.
Before the cuts, a community health worker would have accompanied Dhaka and her baby to the hospital to ensure swift prophylaxis. In Ipusukilo, outside the mining town of Kitwe, a 25-year-old patient named Precious Mulenga came to an HIV clinic in February only to learn that alarming blood test results from the previous July — showing a dangerously high viral load — had never been communicated to her, because there were no community health workers left to track her down.
She was pregnant. The child she was carrying had been exposed to the virus for months, the Times reported.
“Here was another child facing a potential lifetime of infection, and it could have been avoided,” said Ireen Lubwesha, the clinician who ran the Ipusukilo clinic alone for much of last year, as quoted by the Times.
The underlying structural crisis is that despite years of discussion and millions of dollars spent on moving responsibility for services from PEPFAR to Zambia’s own government, the country had continued to let the United States pay for and manage almost everything.
Thousands of critical health workers were still employees of aid groups rather than the Ministry of Health, so they lost their jobs when funding was cut, according to the Times.
Ministry employees had no idea how to use drug- and test-ordering systems, and at clinics throughout northern Zambia, paper records now sit in teetering piles on desks and heaped into boxes, many clinics having lost the funds to pay for internet access, the Times reported.
Now Zambia faces a critical deadline. The State Department has warned the Zambian government that if no new health funding agreement is signed by April 30, all U.S. support will end, the Times reported.
The agreement, as seen in a draft obtained by the Times, ties HIV funding to Zambia granting the United States expanded access to the country’s mineral resources.
Without a deal, Zambia would have to take over buying and distributing antiretroviral drugs, laboratory chemicals and HIV tests entirely on its own — a task health officials say the country is entirely ill-prepared to undertake, according to the Times.
Lubwesha, the Ipusukilo clinic’s sole remaining clinician, said the stakes could not be higher.
“If the stocks we have are the last we will get, what will we do?” she said, as quoted by the Times.
“I always think about it. It will mean death.”
Follow the Vanguard on Social Media – X, Instagram and Facebook. Subscribe the Vanguard News letters. To make a tax-deductible donation, please visit davisvanguard.org/donate or give directly through ActBlue. Your support will ensure that the vital work of the Vanguard continues.
