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Haunted by hopelessness: 12 Zambians share their stories as HIV drugs run out

By Gabrielle Emanuel,

Rebecca Davis, Photos by Ben de la Cruz

Published April 14, 2025 at 7:57 AM EDT

Reverend Billiance Chondwe of the Somone Community Center, a branch of the Pentecostal Holiness Church in Zambia, says that many in his congregation have fallen ill since late January when cuts to U.S. aid shuttered clinics. "We are close to 300 [worshipers] but nowadays we are only less than 150. People are sick at home."

From the pulpit, Reverend Billiance Chondwe counts the empty seats.

"We are close to 300 [worshipers] but nowadays we are only less than 150. People are sick at home," says Chondwe — or Pastor Billy as everyone calls him — as he greeted congregants on a Sunday in early April at the entrance to his church, the Somone Community Center, a branch of the Pentecostal Holiness Church in Zambia.

People are falling ill because the U.S.-funded clinics where they got their HIV medications and care have suddenly been shuttered. The staff is gone. The electricity has been shut off. Some patients have already run out of their daily pills that keep HIV at bay — and they have started to feel the physical consequences of the virus surging back.

The Trump Administration, in January, abruptly halted the vast majority of U.S. foreign assistance in light of their America First agenda. Officials said that lifesaving aid — such as HIV medications — would continue to flow. But the reality on the ground shows otherwise. An untold number of people with HIV have simply and suddenly lost access to their medication.

A shuttered USAID clinic in Kitwe, Zambia. The clinic provided free HIV medications and treatment to the community until it was suddenly closed in late January. People still show up at the clinic for their medicine only to find the lights out and the staff no longer there.

That is largely because the halting of foreign assistance and cancelling of programs crippled the systems that enabled people to get their AIDS medicines. And, of the small number of programs that are technically allowed to continue, many report not being paid by the U.S. government and, thus, having to close their doors and lay off workers. The State Department, which oversees foreign assistance, did not respond to requests for comment.

In 2024, Zambia received $240 million from the U.S. to support HIV/AIDS work, including prevention, treatment and distribution of medications. NPR visited and spoke to many in this southern African nation who have expressed great frustration that the cuts to aid came with no warning and no transition plan. But they also acknowledged that their country had become dependent on foreign aid and that the government needs to do more to fill the vast gaps left by the sudden U.S. withdrawal.

"The main victim that is paying the price of this disruptive decision to cut the U.S. aid funding is the ordinary Zambian person living in poverty," says Chris Zumani Zimba, a Zambian political scientist affiliated with the University of Central Africa. According to the World Bank, more than 60% of the population there lives in poverty. And, more than 10% of adults in the country have HIV — half the rate of a decade ago.

A study out this month in The Lancet estimated what would happen if the U.S. does not continue its flagship HIV/AIDS program that's been pivotal to reversing the downward trend in life expectancy due to AIDS. The researchers from Oxford University and elsewhere found that half a million additional children will die of AIDS in the next 5 years in sub-Saharan Africa and nearly 3 million more African children will be orphaned by AIDS. In many Zambian communities, people say these numbers will soon be more than just a forecast.

Mothers and children, husbands and wives, doctors, truck drivers and religious leaders are all grappling with the fallout of the U.S. cutting aid. Here are stories of those impacted in just one part of one country: Zambia's resource-rich Copperbelt Province.

Dorcas Mwanza, 10, took the last of her HIV medications eight days ago. She's developed a fever and chills, among the first symptoms people experience when they go off HIV treatment.

Dorcas and Theresa Mwanza: Her 'jovial' daughter is now 'miserable'

"Jovial."

That's the word Theresa Mwanza, 32, liked to use to describe her 10-year-old daughter, Dorcas. When Dorcas would get home from school, she'd often play house, pretending to prepare nshima — a thick traditional porridge — for her imaginary family. "I'm thinking she'll be very family-oriented when she grows up," says Theresa in Bemba, a local language spoken in parts of Zambia.

It's now been eight days since both Dorcas and her mom, Theresa, took the last of their HIV medications.

A single mom and an only child, they've always taken their medicine together at 8 p.m. each night. The change in routine has confused the little girl.

Theresa Mwanza, a single mom, holds an empty bottle of her HIV medicine.

"In the past week, she'll open the tin [where the medicine is kept] and find that it's empty," says Theresa. "She'll run down to the clinic to go and check if she can collect her medication. And then she'll come back home and say, 'Oh, you are right. The clinic is closed. They're not there anymore.' "

And it seems like their U.S.-funded clinic is not coming back. The doors of the clinic, which services over 2,000 HIV patients, have been locked since the end of January, the staff let go and the furniture largely removed. This clinic didn't just provide medication, it also provided basic food since HIV medicine cannot be taken on an empty stomach. Theresa and Dorcas lost both.

So far, without their medication, Theresa feels okay. But Dorcas has developed a fever and chills — and she feels weak. Flu-like symptoms are often one of the first symptoms after someone goes off HIV treatment — the level of virus rises and the body tries to fight it off. Worried, Theresa now stays home to tend to her daughter — who often rests on a mat by the tree outside their home. But it means Theresa isn't going house to house to do laundry and odd jobs, their main source of income.

Theresa Mwanza and her daughter, Dorcas, stand in a field near their house. After their USAID-funded clinic closed, Theresa tried to get HIV medications at a government-run clinic but was turned away and told she needed to get "direction or guidance" from that now-shuttered facility.

Theresa tried to get their medications at a clinic run by the Zambian government. It took an hour to walk there only to get turned away. "They keep insisting: 'You need to get direction or guidance from the clinic where you were on where you will go to next,'" she recalls. But with her neighborhood clinic closed, Theresa isn't sure what to do.

She thinks back to her two sisters who died of AIDS before medication became available — and free with help from the U.S. "I am now really worried," she says looking at her daughter. "She's a very jovial little girl, but she's been very miserable the past few days."

Mary Mayongana: 'What will become of me?'

Mary Mayongana, 42, typically spends her days either at the market selling vegetables or in a small family compound she shares with her family: Her mother, her four children, her two sisters and their children. "All of us live here as one big family," Mary says, speaking in Bemba.

Mary Mayongana, 42, is unsure whether her ankle sore is a result of going off her HIV medications. She says that the pain along with the fatigue she now feels are going to make it hard to walk for 45 minutes to reach the nearest clinic after the closure of the U.S.-funded clinic she had previously used.

Now, Mary is confined to that compound. She's lost access to her HIV treatment and feels weak. She's also developed an itchy rash, a classic sign of going off HIV medications — it can be an indication that the body is trying to fight off the resurgent virus and the immune system is weakening. And Mary has another challenge: her ankle is swollen from a painful open sore that continues to spread.

Without warning, her U.S.-funded clinic closed on January 28 with a stop work order from the Trump Administration. Now the clinic's health workers are distributing the remaining supply of medications among all the patients. For more than two months, Mary hasn't been able to consistently take her HIV medication. Sometimes she's gone up to 14 days with no HIV medication at all. Right now, she has a few pills and has decided to take them every third day. It's risky because her body could develop resistance to the drug if it's not taken daily. But, Mary says, it's all she has so she needs her supply to last as long as possible.

For more than two months, Mary hasn't been able to consistently take her HIV medication. She says she feels weak and has developed an itchy rash.

There are Zambian government clinics that still stock HIV drugs but they've been so overwhelmed by HIV patients from the shuttered U.S.-funded clinics that they've been forced to ration the medication, giving out a limited supply to each patient. And for Mary, who has no money for transportation, the government clinic seems impossibly far away. It's a 45-minute walk on a good day.

She's unsure whether her ankle sore is a result of going off her HIV medications but, she says, the pain and fatigue she feels are going to make it hard to walk to the clinic. She thinks it will take her hours each way. Her mother is urging her to do it anyway — together, she says, they can take a few steps, then rest.

"I spend a lot of time thinking about what is likely to become of me, especially that I'm actually seeing myself wasting away," says Mary in a flat, quiet voice. She sits on the cement floor of her brick home, her head resting against the wall. "It's really weighing me down."

Mary stands outside the family compound that she shares with her mother, her four children, her two sisters and their children.

Kabamda Willies and Alice Nyandwa: Remote farmers

When Kabamda Willies noticed Alice Nyandwa working in the farm fields in 2018, he immediately knew he wanted to marry her. The first thing he did was to share his HIV status. "I thought it would be wise to explain to her [that I have HIV] from the very beginning," Willies says, speaking in Bemba.

She then told him, she too is HIV positive. They soon got married.

As subsistence farmers in a very remote area, they got their medications from a community health worker who, for years, would bike to their home with their pills, delivering a six-month supply. And he could even take their blood while sitting in their thatched gazebo and then bike it back to the lab. That suddenly stopped when the U.S. surprised the world by halting the vast majority of foreign assistance.

Now, Kabamda and Alice go to the closest government clinic to get their HIV medications and tests. It's a 3- to 4-hour walk each way. Still, they make the journey.

Farmers Alice Nyandwa and Kabamda Willies say that they now must walk three to four hours each way to a government-run HIV clinic. Even when they get to the clinic, they sometimes can't get their medications because the volunteer staff — who used to receive stipends as part of U.S. aid — aren't there anymore.

"Sometimes when we get to the clinic, the volunteers that attend to us are not there. So we need to arrange to walk back again on another day," says Kabamda, 63. Those volunteers are missing because many of them had received a stipend from the U.S. — and that's now dried up.

Even if the clinic is open and the couple can get served, there's another problem: The days when they'd get enough pills to last 6 months are gone. Now, Zambian government clinics are rationing HIV drugs. The state clinics didn't have warning about the U.S. cutting aid and didn't stock up on medications. So, with the onslaught of new patients, Kabamda and Alice say, they are being given medication for just two weeks. Kabamda says it's hard to find the time to return to the clinic so regularly because "we need to grow our food to eat."

Oswell Sindaza: 'I'm moving like a headless chicken'

When Oswell Sindaza was born, the story goes, his mother looked him over — head to toe — and enthusiastically said: "All is well." And so, that became his name: Oswell.

But these days, such a happy declaration is sorely missing.

"We have over 6,400 [HIV] clients, and I'm just alone as a clinical person," says Oswell Sindaza, a doctor who used to oversee a staff of 21 nurses, doctors, pharmacists and lab technicians that was funded by U.S. foreign assistance.

Sindaza, who's 44, is a doctor for HIV/AIDS patients. Since 2014, he's been running a project funded by the U.S. Agency for International Development which was housed within the Wusakile Mine Hospital. Sindaza used to oversee a staff of 21, including a team of nurses, doctors, pharmacists and lab technicians. The local mining company paid his salary and so, unlike his colleagues, whose salaries were directly or indirectly paid by U.S. foreign aid, he survived the funding cuts. But now, he's the only doctor left.

"We have over 6,400 [HIV] clients, and I'm just alone as a clinical person," says Oswell, adding that there's also one accountant and one nurse who were not funded by U.S. aid. His caseload grows each day as patients, desperate for HIV medications, arrive from nearby clinics that have been closed.

"We just give them drugs. We're not taking care of the clients' needs, things like viral load testing, liver function tests, kidney function. We do not have the capacity to do that," he says. "I'm moving like a headless chicken now just to try and make things happen."

He says he worries about all the patients who can't make it to his clinic — those who live too far away or are in wheelchairs. He knows they have no medication, and he doesn't know how to help. He says he feels like he's failing his patients.

"It's really, really draining me," Oswell says. "I feel maybe I will not manage to cope going forward."

Brian Chiluba: Once strong, now 'weak, weak, weak'

Brian Chiluba, 56, is comfortable at the top of a ladder and used to pushing a heavy wheelbarrow full of paint buckets around. He's a house painter and — with the help of HIV medication, which he's taken for 15 years — he always had the strength to do his work. But no longer.

Brian Chiluba has lost weight and feels increasingly weak since losing access to his HIV drugs that he's received from a U.S.-funded clinic for the past 15 years.

"I feel weakness — weak, weak, weak," he says as his voice cracks.

Since early February, when his local U.S.-funded clinic shut down, he's struggled to get his medication. At first, he managed to obtain a few pills here and there but, now, he's out entirely.

Sitting on a wooden bench by the window with one of his three children nearby, he says he's lost a lot of weight and feels like all the power has been drained out of him.

Snapshots of Brian Chiluba's three children.

Brian's wife also has HIV and has run out of her medication, too. But, so far, she says she feels fine.

The couple went to a nearby government clinic hoping they would be able to get their medications refilled. But, they say, they were told they must bring their medical records in order to register as new patients. So they've been going back to their old clinic to get their files. Every time they go, it's still shuttered. And yet, he says, they have no choice but to keep trying.

"We need to wait until there's someone at the USAID facility," he says.

The Zambian Ministry of Health did not respond to requests for comment on this policy.

Brian worries that by the time he gets his medical record and registers at a new clinic, it will be too late. "I'm going to lose my life, and I will leave my children suffering," he says.

Brian's wife — Annie Chiluba, 47 — is also HIV positive and has also run out of her HIV medication. She still feels ok, she says, but she worries about her husband's worsening health.

Geoffrey Chanda: Truck drivers cry for help

Geoffrey Chanda's phone is going off almost constantly. Truck drivers are calling him. "They are crying," he says. "'We've got no [HIV] medicine. Where do you get [it] from?'"

He has no good answer.

For 15 years, Geoffrey — who is now 54 — has been working with HIV-positive truck drivers and sex workers who hang out around truck stops. After his own brother died of AIDS, Geoffrey left his job as a miner, saying to himself, " 'Let me teach others not to get [HIV].' "

Community health worker Geoffrey Chanda used to distribute HIV medications to long-haul truck drivers and sex workers at truck stops like this one near the border of Zambia and the Democratic Republic of Congo.

As a community health worker, he would periodically pick up a big bag of HIV treatments from a mobile clinic. Then, he'd coordinate with over 200 truck drivers — and even more sex workers. Calling and texting them, he'd figure out when they'd be passing through the border crossing and go meet them to give them their medications and make sure they had all the information they needed about how not to spread HIV.

The dusty parking lots where Geoffrey spent his days are lined with 18-wheelers, many loaded down with freshly-mined minerals. They pause here — at the border between Zambia and the Democratic Republic of Congo, near the town of Chililabombwe — sometimes for days, waiting for permission to cross the border.

It's this type of location that public health experts have zeroed in on as critical in halting the spread of HIV. In the early days of the epidemic in sub-Saharan Africa, the virus fanned out along trucking routes as long-haul drivers frequented sex workers. Still today in Zambia, HIV is a particular challenge along the trucking routes.

Long-haul truckers sometimes pause for days at this truck stop near the Zambian town of Chililabombwe as they await approval to cross the border into the Democratic Republic of Congo. Distributing HIV medicine on trucking routes is critical to stopping the spread of HIV, say public health experts.

Now, with U.S. aid slashed the special effort to prevent and contain the virus in these hot spots has stopped, Geoffrey says. He no longer has the medications to distribute. He no longer has his income — and, he says, he's struggling to pay for food. But, he still picks up the continuous string of calls from truck drivers and sex workers.

Geoffrey estimates that about 20 of the 200 truck drivers he worked with have called and told him they're starting to fall ill without their HIV medications. He says one of his drivers died in Congo. In the arcades and bars that line the main street, Geoffrey has heard it was because the driver didn't have his HIV medicine.

"He died in Congo. [And] bringing the body [back to Zambia], it's very expensive," says long-haul truck driver Roi Silunyange, 54, who also knew the deceased man.

Zambian trucker Roi Silunyange, 54, stands in a parking lot at a truck stop near the border with the Democratic Republic of Congo. He says that he knows a fellow truck driver who died while in Congo because he ran out of HIV medication.

Mwape Shamboko, another driver who is 42 and standing nearby, used to rely on health workers like Geoffrey and the U.S.-funded system to get his HIV medications. He says there was even an emergency number any driver or sex worker could call if something was amiss.

Truck driver Mwape Shamboko, 42, used to depend on health workers like Geoffrey Chanda to get his HIV medications.

"If you're not feeling well, or you need a supply — maybe your medicines have run out — [we] would call that number, and [the community health workers] were always very quick at coming to us and responding to our needs," Mwape says. "So it was a very, very good system. We were not missing our medications."

Now, he says, the calls go unanswered.

Daliso Tembo and Mary Tembo: 'We can't find peace at night'

Sleep is hard to come by in the Tembo household.

Daliso, 49, and Mary, 32, are farmers, growing peanuts and other crops together. When night falls, they are wracked with worry about the future.

He's HIV-positive and, since his U.S.-funded clinic suddenly closed two months ago, his medications are running low. Just 20 days of pills left. She's managed to avoid contracting HIV from her husband by taking a drug from the clinic, known as PrEP, that prevents the transmission of HIV. But now, all of that is in question.

Daliso Tembo and Mary Tembo with one of their five children.

"We can't find peace at night. Sleep has escaped us," says Mary. "We're asking ourselves: What next? What if? He doesn't like to have these conversations, but it's important that we have them."

Mary plays out the worst case scenario in her mind: "If [Daliso] can't access his drugs — and let's say he falls ill and he dies — what then happens to us as a household? Because he's the head of our household. He takes care of us," she says. "And, if anything happens to me — if I find myself [HIV] positive…" Her voice trails off.

Their main concern is about their five children. The youngest is 2 years old and doesn't understand what's happening. But the older ones are worried.

"They're always coming to me to say, 'Give us answers.' I always tell them, 'Let's not have this conversation,'" says Mary. "I know it's not the right thing, but I'm really trying to avoid it."

Daliso and Mary went to a nearby government clinic but were told to come back later when Daliso would have only a few days of HIV pills left. Mary says that clinic is so overburdened by all the HIV patients who lost treatment when the U.S. cut aid, she's afraid they won't have any medications left for her husband.

"This change has really devastated me," Daliso says, his voice filled with emotion. "I'm a man, but what it has done, it has really shattered me."

Catherine Mwaloe: 'What [have] I done to get this illness?'

When times are hard, Catherine Mwaloe turns to music. She pulls out her phone and scrolls to the emotional, religious songs. Lately, the 16-year-old has been listening to a lot of these songs.

Catherine Mwaloe, 16, who contracted HIV from her mother at birth, has one month's supply of HIV medicine left. She worries that government clinics will charge money for the medications, which were previously free.

From the two-room house — under a huge mango tree — that she shares with her grandmother, Catherine lets the lyrics of her favorite song, "Nessa's Holy Spirit," wash over her:

"Jesus I need you to survive.

Oh come oh! Holy Spirit come oh"

Her grandmother, who has the same name, says Catherine has been grappling with two questions for which there are no good answers.

"She began to ask why she's taking this medication, and then I had to explain to her that 'You're HIV positive,' " says Catherine's grandmother. The girl got the virus from her mother at birth but, her grandmother says, "it's been very difficult to get her to accept her situation. She says, 'What is it that I have done to get this illness?' "

"Holy Spirit come,

Come and have your way"

Lately Catherine's question of "why" has been superseded by the question of "how." How will she get her next round of HIV medications when the health center where she got her free HIV medications was funded by the U.S. and has now shut down. She has one month's supply left and she worries that all the government clinics will charge money for the medications.

Catherine and her grandmother hold hands outside their home.

"Even if I go there, they [will] say, we should buy medicines. And actually, I'm a school girl and I don't have money. And [my grandmother] just sells some tomatoes so that she can earn money to provide for the food," Catherine says, in a low, flat voice as a tear traces its way down her cheek. "I've heard that there are many millions of people going to die."

As Catherine listens to her music, she says, her dream of becoming a surgeon one day feels as if it'll never come true.

"Come and do your thing,

Come and be the strength when [I] am weak"

Reverend Billiance Chondwe: His despair returns

As a child, Billiance Chondwe did everything with his twin sister, Charity. They insisted on just one shared dinner plate. They requested coordinated clothes. He played jump rope with her, ignoring the taunts of neighborhood children for playing a girl's game.

Then — in the late 1990s — when they were 17, Charity got AIDS. Billy nursed her month after month. If he left the house, she would call out for him. He missed school to tend to her. When she died almost a year later, the grief was overwhelming.

Reverend Billiance Chondwe at his home in Kitwe, Zambia.

"What I felt was: I'm alone," recalls Billy, who is now 52. "It brought me to my knees. It brought me to a point where, no matter what I can do as a human being, there is a limit."

For years, he couldn't shake the smell of the disease.

Then, in 2004, things started to change. There was a big push by the U.S. government to get HIV medication to Zambia, along with dozens of other countries. Since then, the U.S. has poured nearly $7 billion into controlling the HIV epidemic in Zambia, providing free HIV medications for 1.2 million Zambians.

For Billy, it felt like a weight was lifted. "Despair was taken away," he says. "Children had hope they will grow [up] with their father."

And then, earlier this year, came the sudden pullout of U.S. aid. Overnight, clinics were locked and shutters were bolted shut. All the doctors, nurses, community health workers and volunteers were told to stop working immediately. Patients lost access to their files — and, most important, their medications.

Reverend Billy is haunted by the memory of people dying during the height of the AIDS crisis in the 1990s. The recent pullout of U.S. foreign aid has brought back feelings of hopelessness and despair.

Now — at Billy's branch of the Pentecostal Holiness Church in Zambia — he watches his congregation shrink as parishioners stay home, sick or tending to the sick who can't find another source of HIV medications.

"Yesterday, I received three calls: Two of my members — they are admitted in the hospital. And I received another [call] from a couple — they are sick," says Pastor Billy. The hopelessness he felt during the years when there was no treatment for AIDS has returned. "It haunts me," he says.