‘We were told to stop everything immediately’ — Lesotho HIV programmes collapse after USAID decision

Pepfar was started in 2003 under the administration of President George W Bush. It has been one of the most successful examples of foreign aid in recent history. A large portion of Pepfar funds are distributed through USAID, the aid organisation of the US government. (Photo: Sechaba Mokhethi)

By Sechaba Mokhethi

5 Mar 2025

The US funding cuts have sparked fear of a surge in new infections as antiretroviral medicines become harder to get.

‘We weren’t given time to refer our clients to clinics or ensure they had continued access to their medication. We were told to stop everything immediately. Now, the people we served are left to suffer.” Until last week, Rebonejoang Leoma worked for an organisation funded by USAID dispensing vital antiretrovirals to nearly 1,000 people.

Now the people he served, and hundreds of thousands of others in Lesotho, Tanzania and Eswatini, have been left in the lurch.

Leoma was project coordinator for the Phelisanang Bophelong HIV/Aids Network, a community-based organisation funded by USAID to improve the quality of life for people living with HIV/Aids in Lesotho.

“Our project had 528 beneficiaries on antiretroviral therapy from the LGBTQI+ community and 312 female sex workers in Leribe and Maseru districts,” Leoma told GroundUp.

Without the project, he says, he fears rising viral loads, increased treatment default and a surge in new infections.

“We are talking about the lives of people. They are already suffering, and we don’t know what’s going to happen to them.”

On Friday, the Elizabeth Glaser Pediatric Aids Foundation announced the termination of three USAID agreements covering HIV programmes in Lesotho, Eswatini and Tanzania. One of the largest affected projects, with a $15-million budget over five years, was implemented by the Baylor College of Medicine. The project offered support for prevention, diagnostic, care and treatment in the Mokhotlong and Botha Bothe districts.

“These projects support more than 350,000 people on HIV treatment, including nearly 10,000 children and more than 10,000 HIV-positive pregnant women,” the foundation said. “Terminating these programmes will have a devastating impact on the communities we serve.”

The day everything went wrong

On 24 January, Leoma’s life changed in a single phone call.

“I was at work between 8 and 9am when the executive director called an emergency meeting,” says Leoma. “We were told USAID had communicated that we must stop all work immediately because President Donald Trump had ordered an immediate halt to all activities.

“I couldn’t believe it. I thought I was dreaming.”

That morning, he said outreach workers were already in the field. Leoma had to call them back, recall vehicles and stop all project activities at once.

At first the suspension was expected to last only three months. But last week, management of the President’s Emergency Plan for Aids Relief (Pepfar) in Lesotho called a meeting with all USAID-funded organisations in the country.

“The message was brief and clear: effective immediately, all projects are closed,” Leoma says.

Last Friday, the US Department of Government Efficiency (known as DOGE and headed up by ex-South African Elon Musk) also announced the cancellation of an $8-million award that was to be spent to “reduce stigma, discrimination and violence against LGBTQI+ communities” in Lesotho.

USAID Lesotho Pepfar was started in 2003 under the administration of President George W Bush. It has been one of the most successful examples of foreign aid in recent history. A large portion of Pepfar funds are distributed through USAID, the aid organisation of the US government. (Photo: Sechaba Mokhethi)

For Leoma, the signs had been there, but he hoped they wouldn’t come true. “I didn’t want to dwell on it because it was stressing me out. But the confirmation hit hard. Now I’m back to applying for jobs in a market where competition is brutal. Youth unemployment is already so high in this country. I had been unemployed since 2017 before getting this job in 2020. It’s devastating.”

A 2024 Lesotho Labour Force Survey noted that nearly 40% of the 760,000 young Basotho, aged 15 to 35, remain unemployed.

The timing could hardly have been worse, he says. “We just came from the big spending of the festive season, focusing on new year’s resolutions and children going back to school.”

Lives at risk

The consequences of the closures of projects like this and the Elizabeth Glaser Foundation are already being felt. While there’s no immediate shortage of medication among the people served by Phelisanang Bophelong, accessing it has become a nightmare.

“We used to deliver ART (antiretroviral therapy) and pre-exposure prophylaxis (PrEP) directly to our clients,” Leoma explains. “Now they have to get their medication from health facilities, many of which are rejecting them because they lack referral forms.”

In just a few weeks since the programme’s closure, more than 10 people have called Phelisanang Bophelong’s nurses and community workers, saying they need to replenish their ARVs and wanting to know why the medication is no longer being delivered to their communities.

“These are people who already faced stigma and discrimination at public clinics, about how they dress, how they talk and many other things. Now, they’re being turned away or treated poorly,” Leoma says.

The LGBTI community is particularly vulnerable. “I know these people personally. I’ve worked with them for years. Many would rather die than face the stigma they encounter at clinics,” he adds.

Leoma’s work with Phelisanang Bophelong spanned two critical projects: The Epidemic Control Project (2022 to 2024) and the Sustaining Epidemic Control through Unified Prevention (Secure) Project, which began in October 2024.

Both projects focused on serving men at risk, particularly in the LGBTI community, and tackled the stigma they faced in public health facilities.

“We ran workshops on LGBTI issues and sexual orientation, gender identity and expression for healthcare facilities,” Leoma says. “We saw a significant decrease in reported stigma and discrimination as a result.”

The projects provided more than advocacy. Leoma says they delivered comprehensive HIV prevention and treatment services directly to communities, services that many would struggle to access otherwise.

The government’s response has been slow and uncertain. In her recent budget speech to parliament, Minister of Finance Retselisitsoe Matlanyane made no mention of the USAID crisis.

Speaking to GroundUp, Minister of Health Selibe Mochoboroane acknowledged the growing financial burden: “We might need close to R300-million for a year’s budget, depending on the programmes affected.”

For Leoma, the most painful part is the abruptness of the shutdown. “We weren’t given a chance.” DM

First published by GroundUp.

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The day everything went wrong

Lives at risk