For eight years, Ntombi, who worked at a health organization in Johannesburg, helped caregivers tell their HIV-positive children about the disease they had. She made sure those children stayed on the medications that suppressed the virus. She visited her patients at their homes to get them any food and financial support they needed.
But then, one day in late January, she was told she had to stop her work, immediately. There wasn’t a chance to explain to her patients what was happening, to try to connect them with other providers, or to say goodbye.
Ntombi’s employer was largely funded by a U.S. HIV/AIDS program. That day, the Trump administration announced that recipients of foreign aid had to halt their efforts while it conducted a review.
Now, when Ntombi drives by the clinic where she used to work, she sees the types of patients she used to help standing in a long queue. Before, caregivers of kids with HIV had dedicated providers so they didn’t have to wait to be seen. She’s heard from workers at the clinic that the patients she used to help are asking where she and her colleagues went, and that some caregivers have stopped bringing their children in for appointments.
“It pains me, it really pains me,” said Ntombi, who asked that her surname not be identified. “Knowing that they feel left out that we’re not even there, they can’t see us, they’re going to be seen by people who don’t know their background. Now all of a sudden we’ve vanished.”
Since the Trump administration started dismantling the U.S. foreign aid system in its early days in office — which began with what was framed as a temporary freeze but which has turned into a mass cancellation of foreign aid contracts — much of the attention has centered on the impact on patients left in the lurch and on the diseases now widely expected to rebound as a result, with warnings about hundreds of thousands of new infections and deaths from pathogens like malaria, polio, tuberculosis, and HIV.
But the administration’s moves also were in effect a massive, abrupt layoff of health workers like Ntombi around the world — the bulk of them in sub-Saharan Africa. The U.S. Agency for International Development and specific programs like the President’s Emergency Plan for AIDS Relief, or PEPFAR, funded organizations that staffed doctors and nurses, program managers, and social workers. They worked on nutrition programs, helped mothers have safe pregnancies and births, and tried to protect people from disease-carrying mosquitoes. They ensured patients made it to appointments, aided people recovering from violence, and offered psychosocial support as well as treating diseases.
Now, they are out of work at a time when U.S.-supported nongovernmental organizations have shed jobs broadly or shuttered, unsure of where to turn to find a position that will allow them to continue working in the fields to which they’ve devoted their careers. They’re concerned about what will happen to the people they used to help, and about their own futures.
While a federal judge on Tuesday determined that the dismantling of USAID was likely unconstitutional and ordered that the agency’s operations be partially restored, it’s unclear what impact, if any, it may have on these workers. Most of the agency’s workforce and contracts were already terminated.
“I loved my job. I loved the people I worked with. This job was a big part of my life,” said Zinhle, who worked with survivors of gender-based violence in South Africa’s Mpumalanga province and taught prevention strategies. Like Ntombi and some others, she spoke on condition her full name not be used, with some fearing their comments might affect future job prospects.
“They trusted us, they knew where to go when they needed help,” she said. “Who will advocate for them if we’re no longer in the field?”
Many of the health workers said they were the breadwinners in their families, often supporting not just their own children and aging parents but also their siblings and extended relatives. They described themselves as immensely committed to their fields, often having invested in graduate programs or specialized training to gain new skills and better serve patients. Now they were wondering how they would be able to afford school fees, housing and car payments, and even food.
“I have dedicated my entire career to public health, HIV prevention, and youth advocacy,” said Jimmy Ssengendo, who worked on HIV programs in Uganda. “The funding cuts have shattered my financial stability.”
“If you look at my curriculum vitae, it’s HIV, HIV, HIV, HIV,” said Okoli Chidera Godfrey, who focused on HIV efforts in Nigeria, working with groups like men who have sex with men. “I feel like I have to start from scratch. It’s going to take me a lot of time to find another area to work in, and I already loved the one I was in.”
“Of course I care about myself, but we have these people we’ve been supporting,” said Edison, who was a program manager at an organization in Uganda, working with sex workers, people who use drugs, and other groups more vulnerable to HIV. “People are going to die, people are going to contract HIV, people are going to get TB infections, STI infections, all that.”
Some health workers said they had continued receiving calls from the people they used to work with, who are desperate for help and questioning where they’ve gone.
“You’re leaving those survivors just like that, it’s like abandoning them,” said Lorranchia, a colleague of Zinhle’s working on gender-based violence issues in South Africa. “We’ve just lost everything that we worked so hard for. It’s very hard to see that going down the drain.”
In cutting foreign aid, the Trump administration has said that the slashed programs don’t serve national interests. Administration officials, including President Trump, have also said that U.S. foreign aid was rife with fraud and corruption.
Many of the health workers STAT interviewed said they did not fault the U.S. for wanting to lower the level of its funding for international aid. They also said they hoped their own countries would step in to increase their support domestically.
But they said that the abruptness with which the cuts went into effect — with no warning or time to come up with alternate plans — made the situation so much worse for their patients and for them personally.
“You have plans. You have a salary. You have things to pay. Today I’m going to fix my house and do this and do that. And then all of a sudden, cut off with immediate impact,” said a nurse in South Africa who worked on HIV programs before being laid off. “This was not a process. This was as sudden as a heart attack.”
One morning, the nurse said, she even put on her clothes for work before remembering what had happened.
The nurse noted that she was in a better position than many of the other people she worked with. With her experience, she had been able to start picking up shifts at hospitals. But public health systems in many countries don’t employ people like health counselors. It was only really NGOs that had them on staff.
When Malerato Tsimong’s former patients call her, she directs them to services that are still available. But Tsimong, a nurse who worked in the Johannesburg area, doesn’t tell them about the struggles she’s now facing herself — how to support her mother, and to pay for her housing and car — and instead just says these things happen.
“Some of them look up to us,” said Tsimong, who worked with pregnant and breastfeeding women with HIV, as well as HIV-positive adolescents. “If I’ve lost hope, then where are they going to get their strength from or where are they going to get their motivation from? I’d rather not tell them what I’m going through. I just put up a front.”
Tsimong added, though, that she hasn’t been able to visit the clinics where she used to work.
“I would literally cry,” she said. “I don’t want to expose myself to that type of pain.”
