A programme preventing mother-to-child transmission has become a casualty of Donald Trump’s decision to sharply cut back PEPFAR

8 August 2025 by Pascalinah Kabi

This investigation was produced in partnership with the Pulitzer Centre.

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When the young mother-to-be arrived for the test to tell if she was HIV positive and therefore might infect her unborn child, she found the door to the clinic testing room locked.

The tests had been halted Mareabetsoe Monyamane, 26, was told, and the counsellors who had once given peace of mind to expectant mothers had been laid off.

“My heart sank,” she told the Telegraph.

“I felt helpless. I sat there thinking about my baby – what if I had contracted HIV since the last test?”

For nearly two decades in Lesotho, making sure that women do not pass on HIV to their children has been a cornerstone of the tiny Southern African kingdom’s campaign against Aids.

If women do test positive, the unborn child can still be protected by prescribing antiretroviral drugs, or anti-HIV protective medicine called pre-exposure prophylaxis, or PrEP.

But the programme had been paid for with American aid, which until recently underwrote nearly every level of Lesotho’s HIV response.

The Prevention of Mother-to-Child Transmission (PMTCT) programme has now become a casualty of Donald Trump’s decision to sharply cut back the US President’s Emergency Fund for Aids Relief (Pepfar).

In a country that has the world’s second-highest HIV prevalence, according to the World Health Organization’s August 2023 Disease Outlook report, this is devastating for pregnant women like Ms Monyamane.

Over 800 of the 1,500 HIV counsellors and nurses who once guided women through testing and helped them protect themselves and their babies have been dismissed as casualties of the aid freeze.

The moment she was told she would not be tested “hit me like cold water,” Ms Monyamane recalled.

“I wanted to cry. Some of us even thought of buying self-test kits, but I am one of those who could not afford it.

“I worry even more – not just about the money to buy the test, but what the results might be and what that would mean for my unborn child. I fear for my baby’s life.”

Mamello Nchela, aged only 18, says she is terrified of not taking an HIV test.

She said: “The fear of not knowing leaves me with so many what ifs? I keep asking myself: ‘What if I’m too late? What if I can’t protect my baby?’”

Some 19 per cent of people in Lesotho have HIV and their plight led Prince Harry, the Duke of Sussex, to found his charity Sentebale, to help.

But, Prince Harry and other founders of the charity stepped down earlier this year following a clash with the charity’s chair.

At £54m ($72m) per year, Pepfar accounted for 67 percent of the £78m ($106m) HIV budget for 2024/25, according to Lesotho’s ministry of health.

The US has now agreed to continue only 28 percent of the Pepfar funding, which will be narrowly focused mainly around medicine distribution.

The PMTCT programme has not been spared.

In a health centre built with American money but now without American support, eight pregnant women, aged between 17 and 33, sit inside a yellow-walled room where the cold winter air battles the warmth of a small black-and-red paraffin heater.

They have come for their monthly check-up and health talk with midwife Mphonyane Thetso, who helplessly watches as drama unfolds before her.

“We have records showing that some women delivered their babies in April and May 2025 with invalid (inconclusive) HIV status because they were not retested after we lost our HIV counsellor,” Ms Thetso said.

She explained: “Sometimes a pregnant woman tests HIV-negative at her first visit. Then, when she comes back at 36 weeks for a re-test, she tests HIV-positive. A woman can give birth HIV-positive without knowing it, if she wasn’t retested.

“If she tests positive, we can still prevent mother-to-child transmission with antiretroviral therapy and PrEP

“But you can’t give PrEP to someone if you don’t know their HIV status.”

The concern is shared at the highest levels of Lesotho’s health system. The ministry of health’s HIV/Aids manager, Dr Tapiwa Tarumbiswa, told parliament in May that “HIV-unsuppressed mothers are more likely to infect their children during pregnancy, birth, and breastfeeding.”

There is little hope in Lesotho that the American aid will be switched back on.

Dr Tlohang Letsie, a senior lecturer at the National University of Lesotho said the country lacked minerals that the US can benefit directly from.

He said: “Another factor is that Lesotho seems to be hopeless in engaging the US. The country is simply not doing enough. It appears we are waiting for the divine intervention to blow some spirit of philanthropy into the Americans.”

Maitumeleng Tsiame, aged 17, spent £1.70 ($2.30) on a ticket from Metolong, Thaba-Bosiu to Nazareth Health Centre to take her HIV test.

When she arrived there, she was told instead to travel to St Joseph Hospital in Roma, requiring another £2.95 ($4) for transport.

She said: “I didn’t go to Roma – not because I didn’t care – but because I simply couldn’t afford it. Deep inside, I am tormented by fear. I keep imagining my child being born with HIV because I couldn’t get tested. It hurts. I cry in silence.”

Nineteen-year-old Itumeleng Thamae was also turned away from the health centre, saying it was one of the scariest days of her life.

She said: “I felt like my baby’s life was at risk, and I couldn’t do anything about it. I was overwhelmed by fear – every day I worry if I am unknowingly putting my child in danger.”

Matebello Khoahli’s children are proof that Lesotho’s PMTCT programme used to be effective.

The 40-year-old tested HIV-positive in 2009, but two of her three children, aged 12 and five, have been medically declared HIV-negative.

But she is now worried about her 23-month-old baby, who missed her final HIV test aged 18 months, in April.

She said: “I was told the office was closed because Trump cut foreign aid to Lesotho, and the people who worked there are no longer around.

“My mind was troubled when I was told my daughter couldn’t be tested. Even today, I am still troubled, wondering where I can go for help so my daughter can get her last HIV test,” she said, adding: “When I asked at the Nazareth Health Centre, they told me to go to St Joseph’s Hospital in Roma.”

But Khoahli never made the trip. She did not have the £1.90 ($2.60) needed for transport.

“We are in darkness,” she said.

This story was originally produced and published by The Telegraph. Read original story here: https://www.telegraph.co.uk/global-health/science-and-disease/lesotho-mothers-fear-passing-hiv-to-babies-amid-us-aid-cuts/