Leaning in pain against the wall of her one-room hut, Hadja, a mother of three, worries about who will look after her children if she dies.
The 27-year-old was unknowingly infected with HIV by her husband before falling pregnant in her village in southern Uganda. Since the US made devastating cuts to its global HIV programmes in January, slashing funding, she has struggled to access her lifesaving medication – drugs that would crucially prevent the transmission of the virus to her baby.
“When you go to the government hospital, they don’t give you the medicine. There are days we go to the hospitals and there are no doctors, days when they don’t have drugs,” she says, explaining that she earns just £1.50 a day making and selling pancakes – far too little to afford antiretroviral medication on her own.
“Our lives depend on medicine – without it, our lives are shortened. If I die, my children will suffer.”
The worst-case scenario is already playing out in a neighbouring village, where James, 50, a father of four, is also HIV positive. Lying in agony on a mattress on the floor, he is watched helplessly by his niece, Beatrice, who – along with her teenage daughter – also has the virus. None of them have had access to HIV medication for over a month and a half.
Without antiretroviral drugs, James’s emaciated body is shutting down, infection by infection. Beatrice knows that she and her 14-year-old may be next.
“I’m worried because my daughter has started showing symptoms – her body itches, and sometimes she loses her eyesight,” she says, her voice a whisper. “I am afraid of what may come, and so is my daughter. She keeps asking, ‘How are we going to survive, Mum?’”
In a shocking move during the first few days of his presidency, Donald Trump signed an executive order that froze almost all foreign assistance for 90 days while programmes were reviewed to ensure they aligned with “American interests”.
That meant a halt in funding to the Emergency Plan for Aids Relief (PEPFAR), which was first introduced by another Republican president, George W Bush, in 2003 and is widely regarded as one of the world’s most successful responses to a global disease crisis, saving tens of millions of lives.
Trump’s actions included a stop-work order and a funding freeze for current and future projects, disrupting supplies and treatment, and impacting 20 million people worldwide.
Although a waiver was later issued by Marco Rubio, the US secretary of state, to continue certain lifesaving services, it’s unclear how or if it is being implemented on the ground.
Angeli Achrekar, deputy executive director at UNAIDS, says part of the challenge is that most of the data collection, monitoring, and implementation programmes – the “service delivery ecosystem” as she calls it – were funded by PEPFAR and are now on hold.
And so some 35,000 estimated deaths have already been linked to the sweeping freezes, according to calculations from the PEPFAR Impact Tracker.
In fact, Achrekar says the world was actually on track to end the global Aids pandemic by 2030, but that will be “impossible” if these cuts and disruptions continue.
