In a tin shack on the outskirts of Maseru, the capital of Lesotho, Lieketseng Lucia Tjatji sits beneath a black cloth adorned with a lion's head. To her left are dried roots, powders, and herbs that she now offers to HIV patients.
Deprived of vital medication after US President Donald Trump's February cuts in aid, HIV-positive people are flocking to the 34-year-old licensed traditional healer, hoping to find an effective alternative treatment.
"I have helped people," and "more and more of them are arriving," says Ms. Tjatji, her voice calm.
Lesotho, a small, impoverished mountain kingdom of 2.3 million people landlocked by South Africa, has one of the highest HIV prevalence rates in the world: about one in four adults is HIV-positive, according to the Ministry of Health.
Tjatji, who is also a fashion designer, is HIV-positive herself. The government-provided antiretrovirals she has been taking diligently since 2003 are now limited to three-month refills due to aid cuts by the Trump administration, and she has no guarantee of obtaining more.
"I don't want to die," she told AFP. "I'm so young."
– Holistic health –
Traditional healers, known as sangomas, are respected by many people in southern Africa for their healing abilities and spiritual guidance.
Many sangomas once viewed HIV as a curse from the spirit world, believing that patients had been bewitched. Some even claimed to be able to cure AIDS.
New practitioners, like Tjatji, undergo extensive initiation and training before being allowed to administer the remedies passed down through generations.
"Traditional medicine plays a vital role in the holistic health and well-being of the community," Mpho Roberta Masondo, director of the National Association of African Healers, based in neighboring South Africa, told AFP.
But it does not replace "antiretroviral therapy, which remains the most effective way to suppress HIV," stresses Ms. Masondo, who is also a traditional healer.
– risk of collapse –
Lesotho has been a major beneficiary of US aid in recent years. Health care is the largest sector receiving US funding, with $120 million allocated in 2024, including $43.5 million for the fight against HIV/AIDS alone.
Since 2016, it has received more than $850 million from Washington in funding to fight HIV, primarily through the PEPFAR program.
In early March, to defend the elimination of American foreign aid programs, Mr. Trump cited the example of those intended for Lesotho, which he described as a country that "no one has ever heard of."
In the absence of US funding, HIV programs in Lesotho risk collapsing, some thirty NGOs warned in mid-February.
Nearly half of PEPFAR-funded programs have been cut, including those for HIV prevention through PrEP and male circumcision, and cash-strapped Lesotho appears ill-equipped to fill the gaps.
– “Ineffective treatment” –
Experts fear that the use of alternative remedies could reverse progress made in the fight against HIV in Lesotho, which five years ago reached the United Nations' "90-90-90" target: that 90% of people with the virus be diagnosed, receive treatment, and achieve viral suppression.
"I'm very concerned," said Jessica Justman, senior technical director at ICAP, a global health center at Columbia University in New York.
“Using ineffective treatment is the same as not taking any treatment at all,” she added. It exposes people living with HIV to opportunistic infections such as tuberculosis, meningitis, and pneumonia.
Ms. Masondo, however, points out that traditional methods can provide relief.
“Traditional healing is not just about herbs; it is a holistic and comprehensive approach that strengthens the body, mind, and consciousness,” she says, adding, “the ultimate or real danger is not traditional healing itself, it is misinformation.”
In the hut that serves as her consulting room, Ms. Tjatji says she fears that alternative medicine will not help her because her body may have become accustomed to regular antiretroviral treatment.
Perhaps Lesotho will "produce the pills for us," she hopes.
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