How a health clinic in South Africa is navigating Trump's cuts to HIV funding

0:00It's Consider This where every day we go deep on one big news story. Today, a story about changes in U.S. foreign aid and their impact. A story that begins in Soweto Township, South Africa.

0:15Melda has a leaky roof. Every time it rains, water seeps in under the door of her house onto the dirt floor. Melda asks that we refer to her only by her first name. She and one of her five children are HIV positive, which still comes with stigma where she lives. Do you have your clinic card to me? If you don't mind sharing. She routes through a pile near a mattress on the floor and pulls out two cards that give her access to treatments. So she's showing me her green TB clinic card as well as her ARV treatment card. In South Africa, the country with the largest number of people with HIV, the AIDS epidemic is a lot more manageable than it once was.

0:55That's thanks in part to advances like ARVs or antiretroviral drugs that keep HIV suppressed. Melda and her child take pills every day at 8 p.m. to keep the virus at bay. When Melda contracted HIV, she struggled to even get help from a nearby clinic. She went back four times, she says, but couldn't get help until she met Marissa. Marissa is Marissa Mutswalitsani, a community health care worker from an organization called Sienakekela. It translates to We Care. Community health workers like Marissa help connect people to medical care, though they also provide more holistic counsel for those who need it, like with hygiene or access to food.

1:41That job has become much harder since early 2025. Sometimes you come here and assist with cleaning. But now because of the on and offs, I hardly come. WeCare was largely supported by the U.S. government and specifically by the president's emergency plan for AIDS relief. PEPFAR is credited with saving 26 million lives since it launched in 2003. But the Trump administration is changing how it delivers foreign health aid, including PEPFAR funds, to direct agreements with foreign governments. And in February of last year, President Trump signed an executive order banning all aid or assistance to South Africa, citing discrimination against its white Afrikaner minority.

2:27We Care lost PEPFAR funding early last year. Consider this. A staff of over 30 people is now down to four, some working part-time. What does that mean for their path forward and for the future of the health care they provide?

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3:21It's Consider This from NPR. Community health programs in South Africa have been heavily impacted by U.S. cuts to global aid, which means workers there, people like Marissa Mutzwalitsani of WeCare, are stretching themselves to support low-income people with HIV and AIDS. We recently visited Marissa's office and sat down with her and her three remaining colleagues to learn more about the experiences of the employees who still remain. My name is Ayanda Adams, working with children, living with HIV. My name is Dora Dikotla. Hi everyone. My name is Mamuhato Mukosi. All four women have a personal connection to their work.

4:04Ayanda tells me that her mother died from HIV, but she didn't tell her family. So Ayanda didn't learn until the day before her death. I told myself that I'm the one who's going to educate them and I'm the one who's going to the community and assist them when they are in denial of taking their medication and then when they don't have a knowledge about what is HIV because they think if you have HIV, you are going to pass away, like you're going to die. There obviously have been significant funding cuts to the aid that the U.S. provided to countries, including here in South Africa. What was that like hearing that programs like the ones that you work for were going to lose funding?

4:46I'm seeing a lot of head shaking. For us, it was a shock. It came as a shock. It shattered our lives. We planned that this year we want to change people's life. And if such a situation comes and we are not even prepared, you can imagine if I'm a worker, I'm not prepared. What more with these beneficiaries that I'm working with? It's even worse because some were not yet ready to stand by themselves. We were there to carry them in this journey. I mean, it sounds incredibly personally stressful having to adjust to all of this. How are you all coping with that? It's still hard and painful, to be honest.

5:30It was so unexpected. Those kids needed our support. We were there to support them, to be there for them, always. Even if you are off, they were calling you. But when you tell them that, no, I'm no longer working, they stop trusting you. Today you are there, tomorrow you're not there. So it's still hard, painful for both parties. Remember we were 30 and plus. And then all of us were going to those households to unlock that, to open up to that person again and introduce yourself that I'm Ayanda coming from Sianayayala. She'll ask, where is Marisa? Where is Asipe? So with that, we break the trust with it.

6:16It's the importance of that person to person. You build the relationship with them. You can't just slot somebody else in. Yes, confidentiality now is gone. You mentioned that there used to be more than 30 of you. And now there are just the four of you. How does that change the amount of people and families that you're able to reach? Honestly speaking, I would say we are overweight. Because now I need to take more workload. And at the same time, I'm no longer going to give the quality service that I used to. Because now I have this huge job. because now I'm looking at, I need to go to four, five, six, seven, eight, nine more houses to attend to.

6:59So it becomes, you know, very challenging. Some just pull out of their programs, say, no, I'm no longer interested. When you tell them, no, the funding, they don't even want to know. So it's so difficult. You try to explain to them, though, that it's not about them. It's systemic. The funding doesn't exist. You're not trying to let them down. Their responses, they just don't want to hear it. They just don't want to hear it. I had one that I had a challenge with. Like, she knew we have problems with the funding, but because of the sensitivity of the situation, she just told me, I'm no longer interested.

7:37Yeah. We report primarily for an American audience. I wonder, is there something you think it's important for people in the United States to know about what things look like here, the impact of these cuts, and how it's changed the work that the four of you do? Okay, what I would say is that probably they are not aware that they were making a huge impact on people's lives. There's a saying that says working together, you know, you support each other towards the goal. But now if I'm working by myself, there will be no impact at all. When the program was there, at least the number of new infections were decreasing.

8:21So now that we don't have funding, the number is going up. Because now people are just, you know, what can they do? Because we are no longer there. As we finish speaking, I notice a plaque hanging on a wall in the office. It says, this project is proudly supported by the American people through PEPFAR. This story and all of our reporting in South Africa and Mozambique was supported by the Pulitzer Center. This episode was produced by Matt Ozug, Karen Zamora, and Elena Burnett, with audio engineering by Peter Elena. It was edited by Patrick Jaron Watanonan and William Troop. Our executive producer is Sammy Yenigan.

9:08It's Consider This from NPR. I'm Juana Summers. This message comes from Odoo. If you are currently overpaying on software to run your business, remember this number, 10 ,000. That's the number of new businesses that join Odoo per month. Join Odoo today at odoo.com. That's O-D-O-O dot com.