Key Affected Populations (KAP) in the country, including sex workers, men who have sex with men, and other marginalised groups, are facing heightened challenges due to a suspension of the United States funding triggered by executive orders from President Donald Trump.
Hlomohang Letsie, Project Coordinator for the Key Affected Populations Alliance of Lesotho (KAPAL), this week warned that this funding pause exacerbates existing barriers to healthcare access for these communities.
Letsie emphasised that KAP already struggle to access services at public hospitals due to stigma and discrimination.
“We are the most affected because we are already marginalised,” she said. “While government health facilities appear to function as usual, for us, the Drop-In Centres are closed.”
These specialised clinics, operated by civil society organisations (CSOs), provided tailored health services for KAP, offering a stigma-free environment. With funding cuts forcing their closure, many now face disruptions in critical care, including HIV/AIDS treatment.
“Drop-In Centres were designed for KAP to access health services privately, away from the judgment often encountered at public health centres,” Letsie explained.
Unlike public facilities, which operate from 8 AM to 4 PM, times when sex workers, for example, are typically resting, these centres were open 24 hours. CSOs also delivered medication directly to KAP in their communities, including on the streets at night.
“Without this, many will default on lifelong HIV medication,” she warned, highlighting the risk of rising infection rates and setbacks in Lesotho’s goal of achieving HIV epidemic control by 2030.
While no specific cases of denied access at public facilities have been reported yet, Letsie noted the daily reality for KAP:
“Each day, someone needs a refill, and there’s a new HIV infection every few days among our community. If these individuals aren’t reached, infection rates will climb.” She urged the government to prioritise programs for KAP amid the funding crisis.
The funding suspension stems from a January 2025 executive order by President Trump, imposing a 90-day freeze on most U.S. foreign aid, including programs managed by the U.S. Agency for International Development (USAID).
This freeze halted operations of the President’s Emergency Plan for AIDS Relief (PEPFAR), a cornerstone of global HIV efforts credited with saving over 26 million lives since 2003.
In Lesotho, PEPFAR has invested over US$860 million since 2016 to combat HIV and tuberculosis (TB), supporting the country’s progress toward the UNAIDS 95-95-95 targets (95 percent of people living with HIV knowing their status, 95 percent of those diagnosed on treatment, and 95 percent of those treated achieving viral suppression).
On February 7, 2025, Trump issued a further order cutting all aid to specific countries, including South Africa, citing political grievances.
While Lesotho was not explicitly named, the broader USAID pause has disrupted PEPFAR funding across the region.
A subsequent waiver from U.S. Secretary of State Marco Rubio allowed limited resumption of PEPFAR’s lifesaving treatment services, but prevention programs and community-level initiatives, like those supporting Lesotho’s Drop-In Centres, remain unfunded, leaving CSOs in limbo.
Lesotho’s CSOs last week issued a statement decrying the “abrupt cancellation and suspension of financial support to critical HIV/TB programs.”
They noted that the pause threatens to reverse gains made through PEPFAR and other U.S. initiatives, such as the Millennium Challenge Corporation (MCC), which has contributed US$362 million historically and US$300 million to an ongoing compact.
“The sudden halt has negatively impacted HIV/TB service delivery at the community level, led by CSOs serving affected populations,” the statement read.
With Drop-In Centres shuttered and outreach halted, the ripple effects are already felt. Letsie and other advocates fear that without swift government intervention or alternative funding, Lesotho’s hard-won progress against HIV could unravel, disproportionately harming its most vulnerable citizens.
Ntsoaki Motaung is an award-winning health journalist from Lesotho, specializing in community health stories with a focus on sexual and reproductive health and rights, as well as HIV. She has contributed to platforms like “Be in the KNOW,” highlighting issues such as the exclusion of people with disabilities from HIV prevention efforts in Lesotho.
In addition to her journalism, Ntsoaki serves as the Country Coordinator for the Regional Media Action Plan Support Network (REMAPSEN). She is also a 2023 CPHIA Journalism Fellow.
