SCOTT DETROW, HOST:
It's ALL THINGS CONSIDERED from NPR News. I'm Scott Detrow in Washington.
JUANA SUMMERS, HOST:
And I'm Juana Summers in Soweto Township in South Africa.
(SOUNDBITE OF METAL SQUEAKING)
SUMMERS: Melda has a leaky roof. Every time it rains, water seeps in under the door of her house onto the dirt floor. Melda asks that we refer to her only by her first name. She and one of her five children are HIV positive, which still comes with stigma where she lives.
UNIDENTIFIED PERSON #1: Do you have your clinic cards, Melda? If you don't mind...
MELDA: Sure.
UNIDENTIFIED PERSON #1: ...Sharing with me.
SUMMERS: She roots through a pile near a mattress on the floor and pulls out two cards that give her access to treatments.
So she's showing me her green TB clinic card, as well as her ARV treatment card.
In South Africa, the country with the largest number of people with HIV, the AIDS epidemic is a lot more manageable than it once was. That's thanks in part to advances like ARVs, or antiretroviral drugs, that keep HIV suppressed. Melda and her child take pills every day at 8 p.m. to keep the virus at bay.
(SOUNDBITE OF PILL BOTTLE RATTLING)
SUMMERS: When Melda contracted HIV, she struggled to even get help from a nearby clinic.
MELDA: (Non-English language spoken).
SUMMERS: She went back four times, she says, but couldn't get help until she met Marisa.
MARISA MUTSWELITSANI: Sometimes we come here and assist with cleaning. But now, because of the on and off, on and offs, I hardly come.
SUMMERS: We Care was largely supported by the U.S. government and, specifically, by the president's emergency plan for AIDS relief. PEPFAR is credited with saving 26 million lives since it launched in 2003. But the Trump administration is changing how it delivers foreign health aid, including PEPFAR funds, to direct agreements with foreign governments. And in February of last year, President Trump signed an executive order banning all aid or assistance to South Africa, citing discrimination against its white Afrikaner minority.
We Care lost PEPFAR funding early last year. The organization had more than 30 community health workers. Now there are only four left on month-to-month contracts, some with reduced pay. At their office, I sit down with Marisa and her three remaining colleagues.
AYANDA ADAMS: My name is Ayanda Adams, working with children living with HIV.
DORA DIKOTA: My name is Dora Dikota (ph).
MAMOHATO MOKOSI: Hi everyone. My name is Mamohato Mokosi (ph).
SUMMERS: All four women have a personal connection to their work. Ayanda tells me that her mother died from HIV, but she didn't tell her family. So Ayanda didn't learn until the day before her death.
ADAMS: I told myself that I'm the one who's going to educate them, and I'm the one who's going to the community and assist them when they are in denial of taking their medication and then when they don't have a knowledge about what is HIV because of they think if you have HIV, you are going to pass away. Like, you're going to die.
SUMMERS: There obviously have been significant funding cuts to the aid that the U.S. provided to countries, including here in South Africa. What was that like hearing that programs like the ones that you work for were going to lose funding?
I'm seeing a lot of heads shaking.
MOKOSI: For us, it was a shock. It came as a shock. Like, it shattered our lives. We planned that this year we want to change people's life. And if such a situation comes and we are not even prepared - you can imagine if I'm a worker, I'm not prepared, what more with these beneficiaries that I'm working with? It's even worse because some were not yet ready to be - to stand by themselves. We were there to carry them in this journey.
SUMMERS: I mean, it sounds incredibly personally stressful having to adjust to all of this. How are you all coping with that?
MUTSWELITSANI: Yeah. It's still hard and painful, to be honest. It was so unexpected. Those kids needed our support. We were there to support them, to be there for them, always. Even if you are off, they were calling you. But when you tell them that, no, I'm no longer working, they stop trusting you. Today you are there. Tomorrow you are not there. So it's still hurt - painful for both parties. Yeah.
ADAMS: Remember, we were 30 and plus, and then all of us were going to those households. To unlock that - to open up to that person again and introduce yourself, that I'm Ayanda coming from Siyanakekela. She will ask, where is Marisa? Where is Asiphe (ph)? So, with that, we break the trust with it.
SUMMERS: It's the importance of that person-to-person...
ADAMS: Yes. So...
SUMMERS: ...You build a relationship with them. I mean, you can't just...
ADAMS: ...Confidence...
SUMMERS: ...Slot somebody else in.
ADAMS: Yes. Confidentiality now is gone.
SUMMERS: You mentioned that there used to be more than 30 of you. And now there are just the four of you. How does that change the amount of people and families that you're able to reach?
DIKOTA: Well, honestly speaking, I would say we are overworked because now I need to take more workload. And at the same time, I'm no longer going to give the quality service that I used to because now I have this huge job, because now I'm looking at - I need to go to four, five, six, seven, eight, nine more houses to attend to. So it becomes, you know, very challenging.
MOKOSI: Some just pull out of the program, saying, no, I'm no longer interested. When you tell them, well, no, the funding - they don't even want to know. So just it's so difficult.
SUMMERS: You try to explain to them, though, that it's not about them. It's systemic. The funding doesn't exist. You're not trying to let them down. Their response is they just don't want to hear it.
MOKOSI: They just don't want to hear it. We - I had one that I had a challenge with. Like, she knew we have problems with the funding, but because of the sensitivity of the situation, she just told Mari (ph) that I'm no longer interested.
MUTSWELITSANI: Yeah.
SUMMERS: We report primarily for an American audience. I wonder, is there something you think it's important for people in the United States to know about what things look like here, the impact of these cuts, and how it's changed the work that the four of you do?
DIKOTA: OK. What I would say is that, probably, they are not aware that they were making a huge impact on people's lives. There's a saying that says working together. You know, you support each other towards the goal. But now, if I'm working by myself, there will be no impact at all.
MOKOSI: When the program was there, at least, the number of new infections were decreasing. So now that we don't have funding, the number is going up because now people are just - you know, what can they do? - 'cause we are no longer there.
SUMMERS: As we finish speaking, I notice a plaque hanging on a wall in the office. It says, this project is proudly supported by the American people through PEPFAR.
(SOUNDBITE OF WHOSA MTWANA'S "DOLLAR BRAND")
SUMMERS: This story, and all of our reporting in South Africa and Mozambique was supported by the Pulitzer Center.
(SOUNDBITE OF WHOSA MTWANA'S "DOLLAR BRAND")
SUMMERS: Tomorrow on the program - after global health funding cuts, some clinics that specifically served sex workers have closed their doors.
UNIDENTIFIED PERSON #2: Sex work has been there before I was even born, right? It's something that we all need to face as the whole world.
SUMMERS: We hear from South African sex workers about the challenges they now face in accessing consistent medical care and avoiding stigma and discrimination.
(SOUNDBITE OF WHOSA MTWANA'S "DOLLAR BRAND") Transcript provided by NPR, Copyright NPR.
NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.
