SCOTT DETROW, HOST:
It's ALL THINGS CONSIDERED from NPR News. I'm Scott Detrow in Washington.
(SOUNDBITE OF RAINFALL)
JUANA SUMMERS, HOST:
And I'm Juana Summers in rainy Johannesburg, South Africa, outside of what was once a health clinic.
It's made out of a number of shipping containers. And, on average, every year, it used to serve roughly 15,000 people, but it closed suddenly. All of those people now have to seek treatments elsewhere.
This neighborhood, Hillbrow, was once full of young professionals. Now it's more often described as a slum. It suffers from overcrowding and sanitation issues. One of South Africa's top research centers made it a point to relocate here, as cases of HIV were rising in the surrounding neighborhood, which is a hub for sex work. The Wits Reproductive Health and HIV Institute launched this clinic specifically to serve those workers. It received support from the U.S. government.
JOHN IMRIE: Providing everything - contraceptive care. We were providing HIV testing and ongoing treatment for people living with HIV.
SUMMERS: That's John Imrie. He's the director of health programs at Wits RHI. The rain pours down, and we huddle under umbrellas as we speak.
IMRIE: It was a full HIV service but in a primary healthcare context.
SUMMERS: The clinic's doors have been shut for more than a year. A sign still hangs on the black gate outside. It says, the clinic ended services on January 28, 2025.
It goes on to say, this is because of changes in the United States government that impact all international projects and research. They have told us to stop work until further notice.
The Trump administration suddenly froze U.S. foreign aid delivery shortly after the start of President Trump's second term. And for the Hillbrow Clinic, which was largely funded by the U.S. AIDS relief program, PEPFAR, the flow of money never resumed. There was a time, John Imrie says, when contracting HIV was a death sentence.
IMRIE: Monday morning, you'd ask people, how was your weekend? And then people would say, oh, I went to a funeral. I went to two funerals on Saturday. And there was another funeral I had to go to on Sunday. Sad to say, it was actually the way lots of people's social lives actually existed. That's where they connected.
SUMMERS: That's no longer the case. For over 20 years, PEPFAR funding made a huge impact on the fight against HIV. It transformed AIDS into a chronic condition that can be managed. In recent years, South Africa had reduced its dependence to the point where the U.S. was contributing about 17% of South Africa's HIV budget. But that U.S. funding often went to programs tailored to the people at the greatest risk, programs like the Hillbrow Clinic.
An estimated 60% of sex workers in South Africa have HIV, and they are especially vulnerable because sex work is illegal in South Africa.
UNIDENTIFIED PERSON #1: (Inaudible).
SUMMERS: A short drive away near Gandhi Square, I met with some of them at the offices of Sisonke. It's a nonprofit that supports sex workers. Sisonke has also been affected by U.S. aid stoppages. Their staff of peer educators has shrunk from 34 to nine. Thalita Maleka is one of the nine remaining.
THALITA MALEKA: I love my job. It's one of those jobs that when you're sitting at home on a Sunday, you're like, I can't wait to get back to it on Monday.
SUMMERS: She tells me that the closure of the clinic in Hillbrow sent shock waves through the community of sex workers.
You mentioned that the donor funder clinic that you used to use is no longer there. What happened to it?
MALEKA: They closed because of the American guy.
SUMMERS: There, a reference to President Trump.
MALEKA: I remember when we all received the news, it was very devastating. So by the time I was teaching sex workers about their rights, like the normal routine, and the girls were like, oh, thank God that you were here because now, last week, the clinic closed.
SUMMERS: When the Hillbrow Clinic and others abruptly shut down, some sex workers were able to get HIV drugs in time. Others struggled. Maleka and other peer educators try to connect these women with the care they need, often visiting them in brothels or on the street.
MALEKA: We'd be like, now we brought condoms, lubricants. And if someone wants to be accompanied to the clinic, accompany them just to make sure that they really go to the clinic and get their medication.
SUMMERS: How much have those funding cuts to global aid from the United States changed the work that you do here?
MALEKA: Well, it has changed everything. The money that I'm supposed to buy bread for my daughter, I have to go and help the other fellow sister to say, hey, I can take my money and come to your house. I use my personal finance sometimes.
SUMMERS: Yvonne (ph) is 39 and has worked as a sex worker for 17 years. She asks that we refer to her by her middle name only because of the stigma attached to her profession. The HiIlbrow Clinic was convenient, quick and familiar, she tells me. But now that it's closed, she has to travel more than an hour, taking two taxi rides to a different clinic.
YVONNE: Now I have to dedicate my day and say, I know half of my day, I'm going to spend at the clinic because if I don't get patient there, I might leave without getting services.
SUMMERS: Yvonne says, it can be uncomfortable seeking care at public clinics.
YVONNE: We had transfer letters that had a blue label just to show where we are coming from. That's when the judgment came because they started to call us, oh, the ladies from the blue clinic.
SUMMERS: Detris M'banjua (ph) had a similar experience. When she had to start going to the public clinic instead, she missed an appointment, and she had trouble getting another one. She ran out of medication, and she tells me she had to ask a friend for some because she was desperate to get it. Here, the peer educator, Thalita Maleka, is translating for her.
What did you think about when you heard about the funding being cut that the U.S. was spending on HIV and AIDS care here?
DETRIS M'BANJUA: (Non-English language spoken).
MALEKA: It was very painful and difficult at the same time because she knew that people are going to default because they won't get the same treatment when they go to the public clinic. The nurses in public clinics - they are very abusive and mean.
SUMMERS: M'banjua is HIV positive. She's 49 years old now.
M'BANJUA: (Non-English language spoken).
MALEKA: She started working as a sex worker when she was 18. So health safety comes first, especially now that she knows her status.
SUMMERS: Back in the U.S., the Trump administration has been changing its global health strategy. Instead of interagency programs like PEPFAR, it's now negotiating aid delivery directly with other countries' governments. But diplomatic relations between the U.S. and South Africa are at a low point. President Trump has repeatedly accused the South African government of discrimination against white Afrikaners. South Africa's government strongly denies that. And right now, there is no direct aid agreement between the two countries. Thalita Maleka, the peer educator, says this threatens the broader fight against HIV.
MALEKA: What I would say is that sex work has been there before I was even born, right? And it's something that we all need to face as the whole world. If we want to end HIV and AIDS, then I believe that the whole world needs to come up together and help one another.
SUMMERS: And that's what Maleka and her dwindling team of colleagues will continue to do for as long as they can, regardless of the decisions being made in Washington.
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SUMMERS: This story and all of our reporting in South Africa and Mozambique was supported by the Pulitzer Center. On tomorrow's show, a popular soap opera in the age of the AIDS epidemic...
UNIDENTIFIED PERSON #2: If even if someone in your family is HIV positive, you can still love them. You won't get it by touching them. You know, you won't get it by loving and caring for them.
SUMMERS: ...Behind the scenes of the reboot of "Soul City."
(SOUNDBITE OF THE IBRAHIM KHALIL SHIHAB QUINTET'S "SPRING") Transcript provided by NPR, Copyright NPR.
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