LEILA FADEL, HOST:
Since the Trump administration took office, it has cut billions of dollars in global health programs. That's everything from vaccines to food assistance to treat malnutrition. Throughout all this, the administration has said that lifesaving medications for people with HIV would, however, continue to flow. But on the ground, we're hearing a very different story. NPR's Gabrielle Emanuel joins us. Good morning.
GABRIELLE EMANUEL, BYLINE: Good morning.
FADEL: So, Gabrielle, you've just returned from Zambia to find out more about what's going on. Why'd you choose Zambia?
EMANUEL: So I chose Zambia because, like many countries in Africa, it was very hard-hit by the HIV/AIDS epidemic, which peaked in the mid-'90s. And the U.S. has played a pivotal role in controlling the epidemic, including paying for HIV medication. This has been a bipartisan 20-plus year effort, and it's been very effective. New infections have dropped by almost 40% in the last 15 years. Life expectancy has rebounded. So I wanted to see if those HIV drugs are, as the administration says, still accessible.
FADEL: And are they still accessible?
EMANUEL: Well, a lot of people can no longer get their HIV meds, and now they're getting sick. For example, I went to one neighborhood in Zambia's Copperbelt. Just on the edge of town, there's a U.S.-funded HIV clinic next to a church.
UNIDENTIFIED CHURCHGOERS: (Singing in non-English language).
EMANUEL: And the clinic, it's totally locked up.
(SOUNDBITE OF DOOR KNOCKING)
BILLIANCE CHONDWE: Now, it's closed.
EMANUEL: Reverend Billiance Chondwe tells me that it was abruptly shut down in January when the U.S. issued a stop work order. He lets me peek in.
Did they take out the furniture? And they cut the electricity?
CHONDWE: Yes.
EMANUEL: OK.
A few months ago, this clinic served thousands of HIV patients. Across the country, there are dozens and dozens of clinics like this one - U.S.-funded, now closed. I walk into the neighborhood and meet many of the clinic's former patients. One is 42-year-old Mary Mayongana. Mary is tall but incredibly skinny. And when I first meet her, she's at home sitting on the cement floor, her head resting against the brick wall. In the 2 1/2 months since the clinic shut, she hasn't been able to find a steady supply of her daily HIV meds.
MARY MAYONGANA: (Through interpreter) So there are times when I'll go two weeks without taking my medication.
EMANUEL: Sometimes neighbors give her a few HIV pills. Mary tries to stretch the supply.
MAYONGANA: (Through interpreter) So I'll skip two days and then take a tablet, skip two days and take a tablet.
EMANUEL: It's a risky approach since it breeds drug-resistant HIV, but Mary says it's all she can think to do. Without her meds, she's developed classic signs of the virus coming back - weakness, fatigue, fevers, sweats and a terrible, itchy rash.
MAYONGANA: (Through interpreter) My skin on my arms is peeling. I've got open wounds. I've got an open wound on my leg.
EMANUEL: She's heard there are still HIV drugs at Zambian government clinics, but the closest one is a 45-minute walk, and Mary struggles to even stand.
MAYONGANA: (Through interpreter) I spend a lot of time thinking about what is likely to become of me.
EMANUEL: Mary is far from alone. Oswell Sindaza oversees a free HIV clinic. He used to have a staff of 21, but after the U.S. cut foreign aid, they were all laid off.
OSWELL SINDAZA: We have over 6,400 clients, and I'm just alone.
EMANUEL: Six thousand patients for one doctor?
SINDAZA: Yes.
EMANUEL: And these are all HIV positive patients?
SINDAZA: These are HIV positive clients. So the clinics are really overwhelmed. I'm moving like a headless chicken.
EMANUEL: He says he knows a lot of HIV patients are without their meds, and the virus is rebounding.
FADEL: Wow, Gabrielle, I mean, I'm listening to that, and clearly these lifesaving medications are not getting to where they need to be. And the Trump administration is saying they continue. So where's the disconnect here?
EMANUEL: So the HIV meds are part of this broader system, a complex supply chain and distribution method. And when the U.S. started pulling contracts and shutting down funding, that whole system just collapsed in a lot of places. And I should note the U.S. State Department did not respond to my request for comment.
FADEL: So then who fills the gap here? Does it now fall to the country's Ministry of Health?
EMANUEL: Yes, in many cases, it does. And I reached out to the Zambian Ministry of Health, and they declined to discuss the USAID cuts with me. But in the country, there is this recognition that they were too dependent on aid. Yet at the same time, there is also a lot of outrage that this shutdown happened with absolutely no warning.
FADEL: NPR's Gabrielle Emanuel. Thank you, Gabrielle.
EMANUEL: Thank you. Transcript provided by NPR, Copyright NPR.
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