In Lesotho’s snow-capped mountains, people living with HIV are struggling for survival after sweeping U.S. aid cuts crippled the country’s once-robust health network. Clinics are closing, workers laid off, and patients forced to ration life-saving drugs.

For years, Lesotho — one of the world’s hardest-hit nations by HIV — relied heavily on nearly $1 billion in U.S. assistance through USAID and PEPFAR, the U.S. President’s Emergency Plan for AIDS Relief. The support helped the country reach the UNAIDS 95-95-95 target, with most people aware of their status, in treatment, and virally suppressed.

That progress unraveled when President Donald Trump, on his first day of his second term in January, froze foreign aid and dismantled USAID, abruptly cutting programs in more than 130 countries. Lesotho lost nearly a quarter of its PEPFAR funding, halting prevention, testing, and treatment programs and sending health worker’s home.

Patients describe the fallout as catastrophic. “Everyone who is HIV-positive in Lesotho is a dead man walking,” said miner Hlaoli Monyamane, who can no longer access a full course of medication. Many now ration pills, skip doses, or abandon treatment altogether.

Community health networks — once the backbone of care for sex workers, miners, and mothers — have collapsed. Lisebo Lechela, a sex worker turned HIV activist, saw her USAID-funded clinics shutter overnight. “People still call me for help,” she said, “but I have nothing left to give.”

The State Department has since announced a six-month “bridge” program to restore limited HIV services, but health experts warn that rebuilding infrastructure and trust will take much longer. UNAIDS estimates the aid freeze could cause millions of preventable deaths if not fully reversed.

Lesotho’s Parliament health chair Mokhothu Makhalanyane said the cuts have set the nation back 15 years, calling it a “wake-up call” for self-reliance. Yet with only 12% of the health budget funded domestically, the country remains deeply dependent on foreign aid.

As uncertainty lingers, health workers fear a resurgence of HIV infections and deaths. “Any step backward creates a risk of resurgence,” said Catherine Connor of the Elizabeth Glaser Pediatric AIDS Foundation. For many Basotho, the fear is already real — clinics are empty, and hope is fading fast.