Eswatini, a small landlocked country formerly known as Swaziland that shares borders with South Africa and Mozambique, has long had the unfortunate distinction of having the world’s highest percentage of adults living with HIV. Second is Lesotho, another small nation 500 kilometers to the south that’s entirely surrounded by South Africa. But over the past 20 years, PEPFAR’s support has helped both sharply reduce new infections as well as illness in those living with the virus. Now, many fear they will become sad examples of the damage caused by the Trump administration’s sudden disruption in HIV/AIDS funding.
Both governments already pay for a large percentage of the drugs that have helped drive the progress and have pledged more help. But neither country is likely to make up for the tens of millions of dollars in support they appear to have lost. “We’re at the cusp of achieving epidemic control,” says Christopher Makwindi, who heads the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) office in Eswatini and has worked on the program there for 14 years. “I feel there’s going to be a reversal of all the gains.”