Every day, desperate children in a South African township receiving HIV treatment call Elsie, who has been unable to help them for almost two months.
Before President Donald Trump cut off US foreign aid funding in late January, this energetic 45-year-old aid worker spent her days crisscrossing the township of Msogwaba, about 300 kilometers east of Johannesburg, treating hundreds of HIV patients.
"I was helping 380 children, making sure they were all taking their treatment, had suppressed viral loads, and weren't suffering discrimination or violence," Elsie, who did not want to give her real name, told AFP.
"We teach them to accept themselves as they are, to know that they are loved. I consider them my own children," she says, still in the present tense, out of habit.
Because Elsie is now forced to stay at home, forbidden from contacting her patients. The NGO she worked for, which she doesn't want to be listed for fear of repercussions, helped nearly 100,000 people a year, including many HIV-positive children, orphans, or abandoned children.
This organization was funded to the tune of $3 million annually by USAID, which allowed it to employ about 100 public health aid workers like Elsie.
Now unable to visit the children she was treating, she is expecting the worst. "My fear is that they won't take their medication," she sighs.
Since the program ended, she said, some children have disappeared. She also fears that others are missing their hospital appointments.
"We know each of these children and their problems. Some of them will not survive," she says.
– “Beyond Medicine” –
South Africa has one of the highest rates of HIV/AIDS in the world, with approximately 13% of the population living with the virus, or 7.8 million people, according to government data. The country had 640,000 children orphaned by the virus in 2023.
In February, the government launched a campaign to expand the rollout of antiretroviral treatment, which already covers 5.9 million patients. It aims to reach an additional 1.1 million people by the end of the year.
"The country has the capacity to provide HIV treatment to people living with the virus because almost 90% of the current treatment is funded through the tax/government budget," health department spokesperson Foster Mohale told AFP.
But the US Emergency Plan for AIDS Relief (Pepfar), affected by budget cuts in Washington, supported many programs focused on prevention, counseling, and monitoring and accounted for 17% of the overall HIV response in South Africa.
"It goes beyond just medicine," says Sibongile Tshabalala-Madhlala, head of the Treatment Action Campaign.
"It's connecting you with a caring healthcare worker. It's understanding the challenges and needs of people living with HIV. It's about prevention and keeping them in the care system."
The budget cuts will severely impact human resources in hospitals that are already understaffed and overcrowded with patients, she fears, which risks further lengthening treatment wait times.
The cuts to funding for Pepfar distributed through USAID alone have led to the loss of 15,000 jobs, according to Health Minister Aaron Motsoaledi.
– Feeling of abandonment –
Cutting all funding for Pepfar in South Africa could lead to more than 600,000 additional HIV-related deaths over the next decade, according to a study published in the Annals of Internal Medicine in February.
"People will die," says Sibongile Tshabalala-Madhlala. "Some are already sharing their antiretrovirals. With this disruption, we will see an increase in HIV infection rates and deaths," she adds.
Sitting in his mother's house on a dirt road in Msogwaba, a thin 17-year-old holds his head in his hands.
The teenager, whom Elsie suspects may have autism, is worried about his upcoming appointment. Since his mother can't afford to take a day off work to accompany her son, Elsie used to go with him.
"I feel like we've been abandoned," says the mother. Elsie says nothing else: "I was forced to abandon them... they were counting on me."
English 
French