In April NPR profiled people who couldn't get their HIV drugs. How are they faring now?

Pastor Billiance Chondwe has known 9-year-old Diana Lungu since she was born. He helped her mother done a unsmooth gestation and during Diana's early years. Diana's mother died of AIDS erstwhile Diana was nearing her 3rd birthday. Diana herself was calved HIV positive. After nan U.S. issued extremity activity orders successful January, she couldn't get nan narcotics she needs to suppress nan virus. Chondwe has since helped her registry astatine a authorities infirmary for these medications. Ben de la Cruz/NPR hide caption

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Ben de la Cruz/NPR

In April 2025, we published a communicative pinch nan headline: "Haunted by hopelessness: 12 Zambians stock their stories arsenic HIV narcotics tally out." It looked astatine nan effect of President Trump's cuts to overseas assistance and his extremity activity orders connected HIV affirmative individuals. In August, we reached retired to them again arsenic good arsenic others who support adjacent tabs connected nan HIV/AIDS business to spot wherever things guidelines now. This communicative is portion of our yearly bid "Whatever happened to ..."

This twelvemonth Billiance Chondwe has recovered himself careening betwixt sedate interest for his organization and guarded optimism.

Chondwe — who is affectionately called Pastor Billy by his congregants successful Kitwe, Zambia — knows galore group who are HIV positive. So, connected January 24, erstwhile Secretary of State Marco Rubio issued a memo calling for extremity activity orders connected each existing overseas assistance awards, Chondwe watched successful scary arsenic galore of nan U.S.-funded HIV clinics successful and astir Kitwe abruptly locked their doors.

For Chondwe, that conjured up nightmarish memories of nan 1980s, '90s and early 2000s, erstwhile HIV had decimated his community. The microorganism claimed nan lives of friends and congregants — and, astir painfully, his copy sister.

He worried that these closed clinics foreshadowed a return to that reality. "It brought backmost what we felt [then]: despair, hopelessness. It was for illustration a rewind," he said successful April.

Today that consciousness of hopelessness has been replaced by a consciousness of determination and a bully woody much hope. While nan coming is still difficult and nan early is acold from certain, he says, location has been betterment acknowledgment to nan Zambian government.

"We are welcomed and we are helped"

After NPR's communicative came out, a typical of nan Zambian authorities called Chondwe.

The article had documented really group successful Chondwe's organization were going without their HIV medicine that suppressed nan microorganism and kept them from getting sick. Some were already reporting specified symptoms arsenic weakness, fatigue, fever, sweats and an unpleasant rash — classical signs of nan resurgence of nan virus.

All nan HIV affirmative group profiled had thing successful common: They had received aesculapian attraction from U.S.-funded clinics that were now shut, and they could not find different aesculapian provider. Some had been turned distant from different clinics because they weren't capable to get their aesculapian records from nan closed clinics. Others didn't cognize wherever to go. Still others were excessively sick to make it to a authorities hospital.

What followed nan article's publication was a possibly astonishing bid of events. At first, Chondwe says, nan government's guidance "was to deny, [saying] that location is nary truth successful what we were saying."

Yet this wasn't an lawsuit of full denial. The authorities decided to spot if they could substantiate nan information. Soon officials arrived successful Chondwe's organization and asked to meet pinch galore of nan group profiled successful nan article, checking nan facts and learning astir their business firsthand.

Chondwe's consciousness is that anterior to nan NPR article, nan authorities genuinely did not recognize what was happening successful Kitwe. Perhaps, he says, that's because immoderate different U.S.-funded HIV clinics successful Zambia, including successful nan capital, had been capable to reopen soon aft nan extremity activity orders pinch waivers Rubio issued that allowed them to resume constricted services, for illustration dispensing HIV medication. That was not nan lawsuit successful his community.

The Zambian Ministry of Health did not respond to requests for remark astir nan steps they took aft nan article's publication.

Chondwe says conversations pinch patients convinced nan officials to alteration their attitude. "We gave them impervious and then, from there, we saw a partnership," he says.

Billiance Chondwe — known arsenic Pastor Billy — mislaid his copy sister, Charity, to HIV/AIDS. After she was diagnosed successful 1989, he cared for her astatine home. She died astir 2 years later. "It brought maine to my knees," he remembers. Today he is an advocator for HIV affirmative organization members who person struggled to get their HIV medicine aft U.S. overseas assistance cuts. Ben de la Cruz/NPR hide caption

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Ben de la Cruz/NPR

In mid-June, nan officials signed an statement pinch Chondwe to thief HIV affirmative organization members whose clinics had remained shut. The position allowed him and a squad of volunteers he had assembled to bring these individuals to different facilities: government-run clinics and hospitals. The statement did not impact immoderate costs aliases compensation to volunteers.

This statement wan a memorandum of understanding. It made nan clinics and hospitals alert of nan government's support for nan activity Chondwe and his volunteers were doing.

As a result, erstwhile Chondwe aliases 1 of his volunteers brings an HIV affirmative individual to a wellness attraction installation they are capable to quickly registry arsenic caller patients truthful they tin get free HIV medications arsenic they had earlier — moreover those who had antecedently been turned distant by authorities hospitals because they did not person their aesculapian records. Because of nan memorandum, Chondwe says, his squad tin now telephone officials astatine nan territory level if a diligent is struggling to get services.

"When we spell to immoderate authorities clinic, we are acknowledged, we are welcomed and we are helped," Chondwe says.

His squad now consists of 38 volunteers — religion members and organization members. He estimates that they've helped link astir 3,000 HIV affirmative group pinch caller providers and clinics.

Catherine Mwaloe, a teen successful Kitwe who contracted HIV astatine birth, is 1 of nan group they're assisting.

Catherine Mwaloe, 16, who contracted HIV from her mother astatine birth, did not cognize wherever to get her HIV medications aft her U.S-funded session unopen down successful precocious January. After Zambian authorities officials met pinch her family, she was capable to get nan medicine she needed to support nan microorganism astatine bay. But nan nutrient assistance she erstwhile received has not resumed. Ben de la Cruz/NPR hide caption

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When she first said pinch NPR, she was moving debased connected her HIV medications because her section U.S.-funded session had closed. Mwaloe said that she and her grandmother, pinch whom she lives, were worried that immoderate authorities session would complaint for nan drugs.

"Even if I spell there, they [will] say, we should bargain medicines. And actually, I'm a schoolhouse woman and I don't person money. And [my grandmother] conscionable sells immoderate tomatoes truthful that she tin gain money to supply for nan food," she said successful April. "I've heard that location are galore millions of group going to die."

After nan article came out, she says that authorities officials visited her location to double-check NPR's reporting. Mwaloe was astatine schoolhouse but nan officials said pinch her grandmother, who is her superior guardian. Then, Mwaloe says, Chondwe's squad helped her link pinch a adjacent authorities clinic. She now has a dependable proviso of nan regular HIV medications that support her alive.

"We're starving a lot"

But Mwaloe and her grandma person a caller and pressing concern: getting nutrient for nan 16-year-old's adjacent meal. That's because nan U.S.-funded session that is now shuttered utilized to supply basal provisions for illustration food and beans — modular believe since a personification who takes HIV medicine connected an quiet tummy tin consciousness very ill. That statement ended erstwhile her session sewage nan extremity activity bid successful January.

Catherine and her grandmother, who is her guardian, clasp hands extracurricular their home. They get by connected 1 repast of porridge a day. Ben de la Cruz/NPR hide caption

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Ben de la Cruz/NPR

In an question and reply successful precocious August, Mwaloe said: "From morning, I've not eaten anything, moreover astatine lunch. Is that healthy? You only eat erstwhile you're going to sleep."

When astatine school, she says, she tries not to attraction connected her hunger pangs. "I conscionable disregard this," she says, telling herself " 'I americium not hungry' and continuing sadly." Before bed, she and her grandma eat their 1 repast of nan day: Nshima, a porridge made from crushed cornmeal.

Brian Chiluba — a erstwhile location creator successful his 50s — faces a akin situation.

After his U.S.-funded session unopen down successful precocious January, his proviso of regular HIV curen narcotics began to dwindle. So he'd skip taking nan pills immoderate days. Then he ran retired entirely. During those months, Chiluba says, he mislaid a batch of weight and became truthful anemic he could nary longer work. He worried nan microorganism was returning. Doctors opportunity HIV wasting syndrome – characterized by unintentional weight nonaccomplishment – tin hap erstwhile nan microorganism is not successful check.

Brian Chiluba mislaid weight and felt progressively anemic aft losing entree to nan HIV narcotics that he'd received from a U.S.-funded session for nan past 15 years. He is now capable to get those narcotics from different installation but says he hasn't regained his weight and tin hardly spend to bargain food. Ben de la Cruz/NPR hide caption

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Ben de la Cruz/NPR

Now, Chiluba has a dependable proviso of medicine acknowledgment to a Zambian authorities clinic. But he's been incapable to regain nan weight he lost. He struggles to salary for nutrient and is still excessively anemic to return to work.

"I americium emotion okay but I request a balanced fare and I request to activity difficult to look for food," Chiluba says.

It's not conscionable group who are HIV affirmative who look caller challenges uncovering food. That's besides a interest for galore group who utilized to activity for U.S-funded HIV/AIDS clinics and programs and were unexpectedly laid disconnected successful precocious January pinch nan extremity activity orders.

Geoffrey Chanda worked pinch nan HIV organization for 15 years, astir precocious arsenic a organization wellness worker. His occupation was to guarantee that HIV affirmative motortruck drivers connected nan separator betwixt Zambia and nan Democratic Republic of Congo had nan HIV medications they needed to enactment connected their regular regimen for months connected nan road. The extremity was to support them patient arsenic good arsenic make judge nan level of nan microorganism successful their bodies was truthful debased they could not dispersed nan infection to others done friendly contact.

Community wellness worker Geoffrey Chanda utilized to administer HIV medications to long-haul motortruck drivers and activity workers astatine motortruck stops for illustration this 1 adjacent nan separator of Zambia and nan Democratic Republic of Congo. He mislaid his occupation because of nan U.S. extremity activity bid and has not capable to find employment. Ben de la Cruz/NPR hide caption

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Ben de la Cruz/NPR

The extremity activity bid caused nan mobile session wherever Chanda worked to unopen down. It has not reopened, and he hasn't been capable to find different occupation successful his separator town. He says his life has been upended: One of his 5 children had to driblet retired of assemblage for deficiency of funds, and he can't salary for nutrient for his family. "We're starving a lot," he said complete matter message.

A fewer hours thrust from Chanda's town, Jennifer Mukuka besides worked for a U.S.-funded clinic, delivering medications to HIV affirmative group who lived successful distant areas. In her backstage life, she had taken successful a 9-year-old AIDS-orphan: Diana Lungu. As portion of nan U.S.'s world HIV/AIDS work, backing was provided to support AIDS-orphans and different susceptible children for captious needs for illustration nutrient and schoolhouse fees. Last year, much than 6 cardinal children were supported done these efforts, including Lungu.

"I accent myself [out] reasoning astir Diana — and me, myself, we are almost nan same," says Jennifer Mukuka, who is herself HIV-positive and who takes attraction of Diana, who was calved pinch nan virus. When she couldn't get Diana HIV medications because of nan U.S. assistance cuts, she shared her ain medicine. Ben de la Cruz/NPR hide caption

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Diana mislaid her mother to HIV and her grandma to COVID-19. She ne'er knew her father. Pastor Billy says that until this year, immoderate stableness she has had successful her life is successful ample portion acknowledgment to nan U.S. authorities PEPFAR program, providing some medicine and basal necessities. Ben de la Cruz/NPR hide caption

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Ben de la Cruz/NPR

Then Mukuka mislaid her occupation — and nan nutrient support that Lungu was eligible for. The 2 person been struggling to spend nutrient and are now 3 months down connected their rent, according to Chondwe, who has helped coordinate Diana's attraction since she was born.

Chondwe says he feels a consciousness of alleviation arsenic he helps organization members entree HIV medications. But he besides has a daunting emotion astir really overmuch needs to beryllium done. He says he stays up astatine nighttime worrying astir really group will get nutrient and find work.

He says he uses donations from organization members and group he's connected pinch overseas to supply proscription to clinics and basal nutrient to nan HIV affirmative individuals his squad helps — for illustration Catherine Mwaloe. But he knows that relying connected donations and unpaid volunteers is not a semipermanent strategy. "I'm simply saying, it's not sustainable," he says.

"Triaging a train wreck"

As Chondwe has been navigating this caller scenery successful his area of Zambia, Emily Bass has been moving to portion together what nan HIV/AIDS scenery looks for illustration globally. "I've been really trying to understand wherever nan lights are still connected and wherever they aren't — and why," she says.

Bass is nan writer of nan 2001 book To End a Plague: America's Fight to Defeat AIDS successful Africa, which documents nan momumental activity of President George W. Bush's PEPFAR — nan President's Emergency Plan for AIDS Relief. Since its inception successful 2003, PEPFAR has received bipartisan support and pinch $120 cardinal invested it is nan largest committedness by immoderate federation successful history to conflict a azygous disease.

Even arsenic President Trump has trim billions successful overseas aid, some Republican and Democratic lawmakers person rallied to support PEPFAR and preserve its funding. And Rubio has issued waivers that technically let programs that supply for lifesaving HIV medications to proceed and immoderate constricted HIV prevention work.

However, Bass says, nan extremity activity orders and nan dismantling of nan U.S. Agency for International Development — which ran galore PEPFAR programs — person made for awesome changes and immense variability from 1 PEPFAR-recipient state to nan next.

"We're triaging a train wreck," she says.

A recently published research brief by Physicians for Human Rights, co-authored by Bass, recovered nan disruptions had caused "severe harm." Among nan effects: curtailed entree to HIV medications, drastically reduced HIV prevention activity and harm done to nationalist spot successful home authorities and U.S. overseas aid.

"The implications are enormous, not only successful these communities affected but globally," says Karen Naimer, head of programs astatine Physicians for Human Right and a co-author connected nan report. "The afloat impacts of these assistance cuts are only opening to unfold."

As Bass has mapped nan caller landscape, she's recovered that galore U.S.-funded HIV clinics person reopened and are capable to supply HIV medications. Yet unit person been "rehired pinch little unchangeable contracts and little salaries," she says, explaining that clinics and programs are hedging fixed uncertainty astir funding.

There is besides a batch of uncertainty astir really PEPFAR will run successful nan future. In past years, PEPFAR has engaged successful a months-long process pinch section governments, world organizations and others to develop strategic plans for really different countries and regions will combat HIV/AIDS complete nan adjacent twelvemonth aliases two. Usually, nan resulting location and state plans would beryllium finalized by summer. However, this year, those plans are not yet available.

Adding to nan uncertainty: Many HIV clinics and different HIV-related programs person contracts pinch PEPFAR that will expire astatine nan extremity of nan fiscal twelvemonth – September 30. The unanswered mobility is whether their contracts will beryllium renewed successful full, extended for conscionable a short word aliases simply expire.

The State Department, which houses PEPFAR, did not respond to a bid of questions NPR sent regarding nan authorities of PEPFAR-funded programs, entree to HIV medications successful Zambia and different PEPFAR countries and nan timing of erstwhile Country Operational Plan and Regional Operational Plans will beryllium available.

However, connected Thursday, Jeremy Lewin — a elder charismatic for Foreign Assistance, Humanitarian Affairs, and Religious Freedom astatine nan State Department — said nan U.S. will procure a new HIV prevention drug for up to 2 cardinal group complete nan adjacent 3 years successful countries hardest deed by HIV. He said this will service arsenic a exemplary for really PEPFAR and nan Trump management will attack world wellness successful nan future.

"This is nan type of point we're going to do much of," he said astatine a property briefing. "The management and Secretary Rubio person been doing a batch of activity to refocus and make PEPFAR much effective. Our attraction area is successful commodities and aesculapian breakthroughs."

Naimer says a batch will dangle connected really lawmakers determine to money PEPFAR successful nan coming fiscal twelvemonth and whether they reauthorize nan program. "We still person a constrictive model to act," she says, suggesting that wrong a matter of months nan HIV/AIDS power efforts must beryllium stabilized and strengthened to debar undoing decades of advancement connected HIV curen and prevention.

Pastor Billy delivering a sermon successful April to his congregants astatine nan Somone Community Centre, a branch of nan Pentecostal Holiness Church successful Zambia. He remembers that astatine nan tallness of nan AIDS situation successful nan 1990s, nan funerals became truthful predominant that he was sometimes burying group respective times a week. Even connected Sunday, it would beryllium a speedy Mass and, then, to nan graveyard. He worried that U.S. assistance cuts would return Zambia to that era, but he's connected pinch authorities officials who've fixed him a measurement of hope. Ben de la Cruz/NPR hide caption

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Even if PEPFAR is capable to proceed successful force, Bass adds, nan sweeping assistance cuts wide mean "there's nary genuinely happy ending for this, but location is an opportunity to prevention things that person been sustained by genuinely exceptional community-led action" — for illustration what Pastor Billiance Chondwe is doing.