AIDS is spreading again in parts of Zambia, a year after the United States cut HIV aid
Saulo Kasekela died of AIDS on March 7 in a small town called Mpongwe in the Copperbelt of northern Zambia. He was a 37-year-old security guard who had been admitted to the mission hospital two days earlier. After his body was wheeled out of the men’s ward, a nurse set aside his chest X-ray, a cloudy swab of lungs engulfed by tuberculosis, a hallmark of an advanced, untreated HIV infection. A scrawled doctor’s letter said the X-ray should be kept for medical students.
Of the eight patients on the ward that day, four had AIDS. Lewis Chifuta, 33, was bone-thin, had a fever and could barely recognize his siblings when they reached his bed.
A year ago there was one such case in Mpongwe every month, maybe two. There were 28 new cases in January this year; 28 more in February; seven more in March.
During President Trump’s first month in office, his administration upended much of the world’s flagship HIV program that had saved the lives of hundreds of thousands of people in Zambia. The Zambian government went into emergency mode, desperate to ensure that people with the virus could continue to receive life-saving medication.
But other crucial aspects of the program had to be scrapped – interventions that had helped stop the spread of the virus and protect the most vulnerable people like Mr Kasekela.
Today, a scaled-back system is running with reduced US support, and Zambia could lose that aid entirely in the next few days. The Trump administration has given the Zambian government an April 30 deadline to accept a new health financing agreement tied to expanded U.S. access to the country’s mineral resources.
The government says the deal would provide Zambia with five years of funding and help build a stronger system that gives the country more control. But if Zambia doesn’t sign, officials warn that Washington could cut off all its HIV aid, a situation that health authorities here say would be catastrophic.
What is happening now in Mpongwe is a dark echo of a time that most nurses and clinicians here cannot yet remember. Three decades ago, Zambia’s hospitals were overwhelmed with young men and women dying painful deaths, and the HIV/AIDS pandemic had overwhelmed the health system. Life expectancy had fallen to 37 years.
In 2003, President George W. Bush’s administration launched a historic humanitarian response to the pandemic – the President’s Emergency Plan for AIDS Relief (PEPFAR) – and Zambia was a priority country. By then, a life-saving cocktail of antiretroviral drugs had pushed back AIDS in the United States and other high-income countries, but the drugs cost tens of thousands of dollars and almost no one in Africa could get them.
