Lesotho HIV Care Threatened by USAID Cuts and America First Global Health Strategy
According to reports from Lesotho and a study published in the medical journal Lancet, foreign aid cuts ordered by U.S. President Donald Trump in January 2025 have severely disrupted public health operations in the mountain kingdom, leaving thousands of HIV patients uncertain of their treatment continuity. Lesotho, where approximately 20 percent of the adult population is infected with HIV, lost 1,500 health workers following the immediate defunding of the U.S. Agency for International Development (USAID), according to Tapiwa Tarumbiswa, who oversees the country’s HIV and AIDS programs. Donors including USAID, the Global Fund, and the World Health Organization previously accounted for 97 percent of the national health budget, with USAID alone providing roughly 40 percent.
The sudden funding freeze dismantled grassroots medical delivery networks. Health worker Mathabang, who operated out of the village of Kena at nearly 2,000 meters altitude where winter temperatures plunge to minus 18 degrees Celsius, was fired on the day the funding stopped. Mathabang had been the sole provider navigating rugged mountains and rivers to supply 180-day stocks of antiretroviral drugs to roughly 500 to 600 patients in the area, including 30 children. Following the cuts, patients like 59-year-old Malimpho, who suffers from severe asthma and relies on a grueling two-hour walk to reach the clinic, found their monthly allocations slashed. Malimpho stated that she recently received only a single bottle of 30 tablets instead of her usual six-month supply, raising deep concerns over potential treatment interruptions.
Tariffs, Trade Pressure, and Diplomatic Tensions
Beyond direct health funding halts, the Trump administration exerted broad economic pressure on Lesotho by threatening a 50 percent tariff. This measure targeted the nation’s vital textile industry, which serves as the largest private employer and accounts for one-fifth of the gross domestic product. President Trump referred to the country as “Den afrikanska nationen Lesotho, som ingen någonsin har hört talas om,” prompting sharp rebuke from government officials. Lesotho’s Minister of Foreign Affairs, Lejone Mpotjoane, called the sudden tariff threat “väldigt orättvist” (very unfair), emphasizing the strain placed on bilateral relations.
The America First Global Health Strategy and the Data-Sharing Controversy
In December 2025, U.S. Ambassador Thomas Hine and Lesotho’s Minister of Health, Retselisitsoe Matlanyane, signed a new five-year bilateral agreement valued at 232 million dollars under the “America First Global Health Strategy,” contingent on Lesotho contributing 132 million dollars. However, the exact text of the final agreement has not been made public, and the U.S. Embassy in Maseru has not responded to inquiries from Expressen. Strong local and international opposition followed leaks of an earlier draft version, which indicated Lesotho would be required to supply the United States with patient health data and biological samples for 25 years. Under that leaked framework, if researchers identified a novel virus or drug-resistant bacteria, local clinics and laboratories would be subject to U.S. inspection, and samples would be transferred abroad within five days.
Nineteen major aid organizations formally protested the terms, warning that the agreement could relegate Lesotho to a subordinate standing and compromise national sovereignty. In parliament, opposition lawmaker Nqosa Mahao went as far as comparing the data-sharing terms to “biological warfare.” Across the African continent, reactions to the broader strategy varied significantly. While 21 nations—including Lesotho, Kongo-Kinshasa, Nigeria, and Uganda—signed on, others rejected the terms. Zimbabwe turned down the proposal due to data-sharing concerns, and Zambia objected to conditions tied to minerals and rare earths. Ayoade Alakija, Nigeria’s health envoy and chair of the African Vaccine Delivery Alliance, characterized the Nigerian pact as “en återkolonisering av vårt hälso- och sjukvårdssystem.”
Did you know? Lesotho is entirely surrounded by South Africa and is the only country in the world where the entire landmass lies above 1,000 meters.
Frequently Asked Questions
How severe is the HIV epidemic in Lesotho?
Lesotho faces one of the highest HIV prevalence rates in the world, with approximately 20 percent of its adult population—totaling over 262,243 individuals—living with the virus.
What caused the sudden shortage of HIV medication in rural Lesotho?
The shortage stems from the January 2025 USAID defunding ordered by U.S. President Donald Trump, which eliminated 1,500 health workers and forced local clinics to restrict antiretroviral distributions from six-month supplies down to one-month allotments.
What are the main controversies surrounding the America First Global Health Strategy?
Critics, including 19 major aid organizations and local opposition politicians, have raised alarms over leaked provisions requiring partner nations to share long-term patient health data and biological samples with the United States in exchange for financial support.
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