MARY LOUISE KELLY, HOST:
It's no exaggeration to say the United States changed the course of the HIV/AIDS epidemic, especially in sub-Saharan Africa. What felt like a death sentence 25 years ago is now a manageable chronic condition thanks to many programs funded by PEPFAR. PEPFAR - that's the President's Emergency Plan For AIDS Relief. The U.S. State Department says PEPFAR has saved 26 million lives since 2003. That's when it launched. But nearly all U.S. foreign assistance has been paused, eliminated or changed since President Trump took office last year.
Well, Juana, you know all this very well because you have been reporting on the effects of those changes out in the field. You are just back from South Africa and Mozambique, and I'm hoping you'll give us a little bit of a preview of all your stories to come. Start with why those two countries, South Africa and Mozambique.
JUANA SUMMERS, HOST:
Yeah, so as we were putting together this trip, we called up some public health experts and people who had worked on PEPFAR in the past, and they just started sounding alarm bells to us about the future of this program, and they told us that the disruptions to care and services could cost lives. And many of the people we talked to, the programs that they were once working for, they no longer exist because of these global aid cuts. So I wanted to go. We wanted to see firsthand what the impacts were. So we picked two countries with very different stories, very different budgets. And I'll just note that all of our reporting has been supported by the Pulitzer Center.
KELLY: OK, thank you, Pulitzer Center. And start with South Africa. Why did you go there, and what did you learn?
SUMMERS: I mean, it's really still at the center of the AIDS epidemic. Roughly 17% of people as of 2024 have HIV there. And it's a country that is in a better position than most in Africa to handle things. But I'll just note that right now, there is relatively no U.S. aid flowing into that country. And though things are better now, when you talk to people in South Africa, they remember how bad things once were. On our first night there, I met a man named Lucky Mazibuko. He used to write for South Africa's biggest newspaper. He's HIV positive, and he came out and disclosed that in his column at a time when there was just still so much stigma and discrimination around HIV. And so many people were dying that he told me South Africa was, quote, "filled with the stench of death."
What made you decide to be more open?
LUCKY MAZIBUKO: I had no choice. It makes me very emotional. Can we...
SUMMERS: Yeah, of course.
And Mary Louise at this point in the interview, he walked away. We had to take a break. And when he came back, he explained to me why this was so emotional for him.
MAZIBUKO: We suffer from post-traumatic disorders. Even today, I hardly go to a funeral, to the cemetery. We buried a lot of people.
SUMMERS: Today, the people who are at most risk are marginalized communities, like men who have sex with men, young girls and women, sex workers and drug users. They're all at high risk and can have challenges when it comes to accessing preventative care. And when I talk to people there in South Africa, they told us the groups that are serving these specific communities are the ones that suffered when the U.S. cut funding.
KELLY: OK, so that's South Africa. And then you traveled - what? - north across the border...
SUMMERS: That's right.
KELLY: ...To Mozambique. Why? Why go there?
SUMMERS: It actually has a lot to do with President Trump. You might remember this. Early 2025, a week into the president's second term, he bragged about these early cuts from Elon Musk's DOGE team.
(SOUNDBITE OF ARCHIVED RECORDING)
PRESIDENT DONALD TRUMP: We identified and stopped $50 million being sent to Gaza to buy condoms for Hamas - 50 million. And you know what's happened to them? They've used them as a method of making bombs.
SUMMERS: So quick fact checked here - no condoms were being sent anywhere in the Middle East. And the Gaza in question was probably Gaza Province in Mozambique, which has a high prevalence of HIV infections. It's the only province in the country where 1 in 5 adults is living with HIV. Now, Mozambique is a lot poorer than South Africa, but the country has negotiated a deal with the U.S. State Department to preserve some global health aid. So there's still some funding going in, but not as much as there was before. And that led to cuts for some programs.
There's one in particular that we've been reporting on. It's called DREAMS. It supported adolescent girls and young women at high risk of HIV. And I met this one young woman who was a participant in the program. And because she was in this program, she was able to actually get paid job training. She became a mechanic, and she told me that because she was able to get that training, she doesn't have to sell her body.
KELLY: You know, I know firsthand when you go out into the world and you're reporting on a trip like this, there's so many things that will stick with you. I wonder, is there one story, one thread you were tugging on that's going to stick?
SUMMERS: I think the thing that sticks in my head, honestly, is the amount of resilience that I saw in both countries. There were so many aid workers who are doing their jobs without pay or reduced salaries or even dipping into their own pockets to do their work because they wanted to keep being of service. I'll give you one quick example. We visited an organization in South Africa that was funded by PEPFAR. They used to have more than 30 community health workers. Now, after the Trump administration cuts, there are only four workers left. I asked Marisa Mutswelitsani how she and her colleagues are coping.
MARISA MUTSWELITSANI: Yeah, it's still hard and painful. Those kids needed our support. Today you are there. Tomorrow you are not there. So it's still hard, painful for both parties.
SUMMERS: And the concern is really, Mary Louise, that the impact of cutting programs like this one all across the region, it's really impossible to quantify that right now, and people just fear things could get worse.
KELLY: Yeah. Well, thank you for that preview. I can't wait to hear more of your reporting as the stories roll out.
SUMMERS: Yeah, thanks so much. We'll be running all of our stories starting on Tuesday. Transcript provided by NPR, Copyright NPR.
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