So we're sitting here, and Mary, you've just taken your kids to school. You've been trying to get them to school, but they keep coming back. What is the issue? The issue is that I don't have the school fees, the money they want. This is Mary. She's a former sex worker in Kenya. She's speaking with the post-Nairobi correspondent Catherine Horrell. They're talking about her current financial situation and why she doesn't have enough money to pay school fees for her kids.
She lives in the capital, Nairobi, and Catherine says that until recently, Mary had been working in HIV outreach in her community. She's one of the people that has been trying to change things for the better. She has been trying to educate her community about the dangers and about the treatment, how to protect yourselves. what to do, how to live positively. That's what she calls it. Mary's work received funding from USAID, the U.S. Agency for International Development.
which delivers billions of dollars of life-saving food, water, and medical aid to people around the world. You know, she was just scraping by. She got about $100 a month stipend from this program that she worked for doing HIV education outreach. You know, they were hanging on by their fingernails, but they were hanging on. But then everything changed when President Trump took office in January. Just suddenly, there was nothing there. They were just tumbling through thin air.
On his first day in office, Trump signed an executive order pausing nearly all foreign aid. And pretty immediately, the money Mary and her family relied on stopped coming. On top of that, there were also disruptions to an HIV-AIDS program that Mary and millions of others have relied on, called PEPFAR, which stands for the President's Emergency Plan for AIDS Relief. This is globally recognized as one of the most successful.
health programs in the history of the world and you know it's been winning and now we're definitely going to see some more victories by the disease and that has already happened because of some of these interruptions that's the thing it is a death sentence From the newsroom of The Washington Post, this is Post Report. I'm Colby Akowitz. It's Monday, April 7th.
Today, the legacy of the U.S.-led fight against HIV-AIDS, its uncertain future under the Trump administration, and the life and death consequences for people like Mary. And just a warning, this episode includes references to sexual violence and assault. So please take care while listening. Katherine, hello. Hi there. You've been spending time with a woman named Mary in Kenya, and I should say that we're only using Mary's first name to protect the identity of her kids and their HIV status.
And we just heard a little bit about what she's going through, but... Can you tell me more about her and why we're hearing from her? What is her backstory? So Mary is a hustler. And Mary is somebody who loves kids. I have eight kids. Four of them are not mine. They're not my biological. I adopted them from their mother when she passed away. And Mary's somebody who cares about her community. I am an activist also. I advocate for the right of sex workers and young women and women.
And she's a woman who has managed to build a life for herself and her family, despite... All these knocks that life has given her. My mom used to be a sex worker. Her mother was a sex worker who was murdered when Mary was two years old. She was raped when she was 13 and had her first child. She went on to have several more children. And then when a colleague of hers, a friend of hers was murdered by a client.
She ended up taking home those four children from the woman's funeral because nobody else wanted them. So she's always trying to help people. I have a lot of issues going on. I tackle them. She lives in a two-room apartment with all these children, except for one who's at boarding school.
You know, you can see how much care she takes there. She set up a reading corner for them. She has a sign on the bathroom door, you know, sternly exhorting everybody to keep it clean. She's got a pile of school shoes in the corner for them. And the thing I love the most is she's got a little poem from her kids taped up next to her mirror with a rose, a plastic rose. And I really like that. What does the poem say?
It says, thank you for your parenting and we believe in you and we love you. Oh. So Catherine, you and Mary, you both live in Kenya. And I want to try to understand the region a bit better. What is the situation like there? And what stands out to you about Mary's neighborhood in particular? So Kenya is the most stable and prosperous country in East Africa and is also America's closest ally in Africa.
Kenya is a country of a lot of contrasts. There's obviously these extremely high-end luxury lodges where people come to look at rare animals and go on safari. But there's also neighborhoods in Nairobi, like the one that Mary lives in. where, you know, there's no paved roads just outside her house. The kids have to pick over puddles of sewage to get to school.
It's very dangerous at night. You know, when her gas ran out recently when she was trying to cook her kids a meal and she had to venture out into the night. with her pot to try and cook it on a neighbor's stove. It's really dangerous because there's gangs that hang around out there.
And there's not a lot of economic opportunities. So a lot of the women and some of the men do resort to sex work just to pay the bills to feed their children. A lot of the people doing the sex work are actually mothers trying to feed their children. So it's very common. And we heard Mary describe herself earlier as an activist and an advocate for sex workers and for women. What exactly does she do to support them in the community?
She set up an organization called The Night Nurses. And when she first saw me writing that down, she said very firmly, that's night with a K because she's a fighter. I do empower female sex workers to negotiate and... Basically, she's the person that the sex workers call when they have a problem, if they've been arrested, if they're being held hostage by a client, which happens quite often, if they're being robbed or threatened.
And some of them sometimes are being arrested illegally. Also, we do follow up. The police call her when they find a body because they get murdered quite often. So everybody knows Mary. And several times... While I've been with her, people have phoned her just asking for money, you know, to feed their kids or, you know, somebody needed a policeman bribed after they got arrested. women needing health care for an emergency situation. You know, her phone never stops ringing.
And I know she also does a lot of work in HIV prevention and care. I imagine HIV is pretty prevalent there where she is. Yes, so a lot of the sex workers have HIV. And some of their older children do as well. But in recent years, most of the HIV-positive mothers have managed to get medication that stops them from passing it on to their younger children. One of the children that Mary cares for has HIV. But Mary's been very effective at getting her medicated and supported with food.
Yeah. Tell me a little bit about the medications that exist now for HIV that kind of helps keep HIV at bay. And that are these life-saving treatments. So HIV stands for the human immunodeficiency virus. And that's a virus that attacks the body's immune system. And HIV, if left untreated, eventually develops into acquired immunodeficiency syndrome.
And that's the most advanced stage. It makes a person much more vulnerable to infection. So really simple diseases, even the common cold, can kill you off. So the first line of medication, the antiretrovirals, which are usually called ARVs. Those cost about 15 cents a day. And they're very cheap, very widespread. And they can suppress the viral load so effectively that people don't pass the virus on anymore. And is it the type of medication that you have to take?
Every day at the same time, it's like very important that you stay on a schedule. It is super important that you stay on a schedule because otherwise the medication can cease to be effective. You might have to go on to a different drug regime, which is much more expensive. or the virus can come back very quickly. So any break in this drug regimen is of great concern to people. HIV is transmitted through things like sex. It can be through mother to child when you're giving birth.
But one of the great successes is that... these drugs prevent mother-to-child transmission. And so that means if you're pregnant and you know you're HIV positive, they can give you drugs so that your baby can be born healthy. So there's been lots of pretty effective efforts to prevent and treat HIV AIDS in sub-Saharan Africa by Mary and many, many others. And a lot of that has been through this program we mentioned earlier called PEPFAR.
How did that get started? I mean, around the year 2000, you had a generation of people that were dying, and so many more were infected. When PEPFAR was created, you know, this immediately started driving down deaths. The U.S. launched PEPFAR in 2003. It was the president's emergency plan for AIDS relief. And that was the single largest public health initiative by any nation in the world aimed at a disease. Seldom has history offered a greater opportunity to do so much for so many.
It was a bipartisan program. that was introduced by George W. Bush. This comprehensive plan will prevent 7 million new AIDS infections. Treat at least 2 million people with life extending drugs and provide humane care for millions of people suffering from AIDS. and for children orphaned by AIDS. And he really drove it forward. And he called it a work of mercy. And that's really what it has been. It's saved people from becoming orphans.
It saved people from dying. It saved people from becoming infected because there was more testing and then there's more drugs available. to the point where now, you know, the number of deaths, those numbers have dropped dramatically. And in Kenya, we had... I think more than 150,000 people dying of AIDS the year that PEPFAR was founded. And then by 2023, that had dropped down to 20,000 deaths. So you've seen this program have an enormous impact.
And one of the most amazing things is that the increases in testing and treatment were driving down death and infection rates. so low to the point where HIV could be eliminated as a public health threat for most of the world by 2030. So yes, there would still be people dying. There would still be people being infected. But really, they were aiming towards 95% of people detected and 95% of people on treatment. And when you reach that point... you've really got the disease under control.
After the break, how major disruptions to PEPFAR and other U.S. support are already affecting the global fight against HIV. We'll be right back. I'm Robin Kavan, and I'm the senior critic at large for The Washington Post. I write about politics and race and the art. There's so much information and misinformation coming at people. And for me, a critic's job is to really cut through that. and attempt to direct people towards what is of value. Subscribers are definitely the most engaged.
And they're the ones that I feel like I'm most often having a conversation with. People who are really engaged in our culture and engaged in civic life in a way that... can be really transformative. When you subscribe to The Washington Post, you support this kind of journalism. I'm Robin Givon, and I'm one of the people behind The Post.
Okay, real talk. We're all kind of hooked on our phones. It's full of shiny apps designed to keep your attention captive forever. But there's real life stuff to do other than scrolling. And I'm here to help. I'm Christina Quinn, the host of Try This, a podcast for... noisy and distracting world. So let's tame the beast together. Find Try This from The Washington Post wherever you listen.
So, Catherine, this all brings us to the current moment. President Trump takes office and issues a series of directives that upend foreign aid, including an executive order within hours of taking office. What exactly did that order do and what was the thinking behind it?
So that executive order put a 90-day freeze on nearly all global aid, including PEPFAR. And President Trump said that the reason for that freeze was they wanted to make sure that American taxpayers' money was being spent properly. And there were a lot of allegations that were made that were never really substantiated or turned out to be completely false. Like this allegation that the USAID spent $50 million on condoms in Gaza. We identified and stopped $50 million being sent to Gaza.
to buy condoms for Hamas, 50 million. And you know what's happened to them? They've used them as a method of making bombs. Which was completely untrue, but was repeated by members of the administration for weeks after it was thoroughly debunked. Yeah, I remember that. And then there was that moment where Elon Musk, the head of the Department of Government Efficiency, which we all know as Doge, was asked about this because he had promoted that exact false claim on X.
Well, first of all, some of the things that I say will be incorrect and should be corrected. So nobody's going to bat a thousand. I mean, we will make mistakes, but we'll act quickly to correct any mistakes. I'm not sure we should be sending $50 million worth of condoms to anywhere. So Catherine, getting back to your reporting in Kenya, what exactly has been happening on the ground there as a result of this shakeup in foreign aid and PEPFAR funding? Clinics were shot.
Doctors were sent home. People distributing the medicine were sent home. outreach workers stopped going to schools or places where there were vulnerable people. I mean, did they make any exceptions to the funding freeze? So there has been efforts to restore some of this programming. On January 28th, the U.S. Secretary of State said that lifesaving programs should continue.
The U.S. Secretary of State issued a waiver on the pause for life-saving humanitarian assistance during the 90-day period of review. The White House press office said in an email to the Post that... programs serving 85% of people who benefit from PEPFAR. were up and running again and that payments had been made to unblock, quote, the most critical bottleneck. But that's not what my reporting found. Some big programs are still frozen, like those supporting HIV positive orphans.
And others are struggling to restart because so many of these programs are interconnected. So, some USAID PEPFAR programs were frozen and then were given a waiver because they were considered life-saving, but the people that were supposed to distribute the money had been sent on leave.
Some NGOs were granted waivers for some work, but then the other people that they were working with didn't get waivers. So you might have a clinic that was authorized to open, but nobody being paid to go there. It's been... so sudden and so unpredictable that nobody has any idea what's going to happen next. Okay, so let me make sure I'm understanding. So first, the Trump administration froze nearly all foreign aid.
Then Secretary of State Marco Rubio issues some exemptions, including for certain HIV and AIDS work. But even when some of that funding was in theory restored, there was so much damage to the other parts of the system that it was basically already paralyzed. The problem was by then the payment mechanism had been dismantled.
While you might be granted a waiver to continue your work that would exempt you from this funding freeze, there was no way to pay you. There was so much confusion over their implementation. You might get a waiver, for example, to open a clinic, but not one to pay the staff that were supposed to be coming there or provide the medicine. It's a bit like putting an axe through the bottom of a boat and then saying, well, you're welcome to use this boat to cross the river.
It just doesn't really work like that. You're going to sink halfway across. And unfortunately, that's what was really happening. So Catherine, let's go back to Mary. What has changed for her since... The Trump administration put the freeze on this funding. Well, most of her income came from doing this outreach to vulnerable communities. All of us, we were told not to go back to work. So we are not working. It just stops there. So obviously her income stream has been cut. She can't pay the rent.
She's been in hiding for the landlord for the last two months. Her kids have been thrown out of school because she can't pay their school fees. I've walked with her to school in the mornings and seen the teachers turn them away. She is struggling to feed them. You know, she might be able to make a meal just of porridge sometimes. And the HIV positive girl that she cares for has really been struggling because...
She's scared of dying. So is she not on her medications currently? Is she able to take them? So she is on her medications. But if you're used to getting three months of medication, And then suddenly, with no warning, they tell you... The Americans have stopped funding this program and you can only have a month. And then you get down to your last couple of days.
You might be scared, and I know that they have been scared, that if you go to the clinic for your refill, that refill isn't going to be there. Because this was so completely... That there's been no opportunity for the government to plan and get extra funds to cover this kind of medication. Nobody knows how much that they actually have left. That sounds like...
A harrowing situation to be in for Mary. I think it's particularly scary for her because she's always really done her best to protect her children. And this is something that she can't protect them from. and she's gone around from clinic to clinic. to wheedle or beg or cajole doctors into giving her extra pills.
They have all refused because of this nationwide directive to kind of ration the medicine for now. Her 15-year-old daughter is at boarding school across the country and she had to send her with only... one month's worth of medicine, which obviously was running out. And so the girl stopped concentrating in class. Her teacher, who was the only one who knew her status, called Mary and said, you know, your daughter isn't doing any work now. And she says she's afraid of dying.
So Mary had to find a way to get her some pills in Nairobi. and then how did you send it with the bus so that's more extra money yes you have to yeah you have to pay And she managed to send them to her on a bus, which was an extra cost. But she had to confide in another teacher at the school. She didn't want the girl's status to be disclosed.
There's a lot of stigma around HIV. And that teacher told other teachers. And one day when the girl was not concentrating in class, one of her teachers said to her in front of her entire class, The teacher called her and she was not hearing the teacher calling her name. So she just said, Why aren't you concentrating? Are you thinking about your HIV medication in front of all the other students? And it is so harmful.
So now all the people in her school know about this? The classroom. Of course, now the school, I believe, because gossiping is allowed. So now everybody knows her status and she's totally devastated. Yeah, God. So the situation that Mary's facing, how common is this across Kenya? Have you been talking with other people who are also facing these similar challenges? Yes, unfortunately, so many parents and children are facing these kinds of challenges.
with Mary to a clinic in her neighborhood, and we met a couple of ladies there. One, her name was Florence, and she was the cleaner there. And she and her eldest daughter are HIV positive because when her eldest daughter was born, she didn't get that medication that stops you from passing it on to your babies. Her three youngest are HIV negative.
And she said her eldest daughter had been trying to comfort her by saying, you know, Mom, I know things are really tough right now and you've lost your job, but at least, you know, if I die, you won't have to pay for food for me or for school fees. So you won't have to worry about that. And that's how she's trying to comfort her mom. I can't imagine as a mom.
hearing your child say that. She started to cry when she was saying that. And then she was saying, and what can I tell her? I can't tell her it's going to be okay because I don't know if it's going to be okay or not. And this woman is still turning up to clean the clinic for free. She's been there for the last two months, cleaning the clinic for free, just to kind of get away from her kids and get a little bit of a headspace.
Nobody's paying her and she doesn't have anything to bring home for food. So what are some of these women doing now? Are they doing anything to make money? Well, some of them are trying to go back to what they know best, which is sex work. I met this. lovely lady called Tams in a clinic with Mary. I told her that I'm HIV positive. And she asked us not to use her full name because...
There's still a lot of stigma about living with HIV in Kenya, and she didn't want to be identified, and she didn't want her children to be identified as well. She's 37. My work was dealing with the community. Like a field officer was talking with the ladies and people who are living with HIV.
My work was mobilizing them to pick the drugs, yeah. So how is your situation right now? My situation right now, I'm trying to... I had a lot of stress. My situation now is not good. I don't know if I will survive. She said that she had tried to go back to sex work.
And she couldn't get a client. And then she couldn't go back home because she couldn't face her children to tell them that she had nothing to feed them. If these clinics aren't there, if people like Tams and Mary can't do the outreach that they've been doing. Are we expecting to see the rates of HIV increase again? So there has been some modeling by UNAIDS that shows if all PEPFAR funding is cut.
that the death rate will spike higher than it was 20 years ago, that it will be the worst it has ever been in terms of deaths and infections. It's active in 55 countries around the world. It supplies life-saving medicine to more than 20 million people right now, including 560,000 children. So if PEPFAR was permanently halted, UNAIDS estimates that there would be an additional 6.3 million AIDS-related deaths.
3.4 million AIDS orphans, 350,000 new HIV infections among children, and 8.7 million new adult infections by 2029. So that's just in the next four years. It doesn't look like all PEPFAR funding is going to be cut. You know, we won't see it go that high, but we know certainly that it is going to jump. Now, how far it's going to jump, we just don't know. So, Catherine, has there been a push to restore these funds? Has there been any outcry?
that these funds have been cut. So, yes, I mean, there's been strong bipartisan support for PEPFAR. A lot of health advocates and a lot of lawmakers from both sides of the aisle have spoken out in support of it. And I think that's the reason why some programs did get waivers. We've also seen legal challenges to this executive order. The AIDS Vaccine Advocacy Coalition filed a lawsuit on February 10th. against the foreign aid freeze. The problem is, you know, these...
lawsuits have seen a lot of temporary stay orders, you know, that might last for a week. It's not really clear what's going to happen next. So basically the sort of the chaos continues and nobody knows what's going to happen week to week. Catherine, I know that The Post has also reported that since the legal challenges you mentioned were filed, the Trump administration has moved.
to formally close USAID. And so I imagine there's likely going to be more challenges and more uncertainty. I think there might be some people listening who will wonder, why is it the U.S.'s responsibility to maintain these programs and support these families across the globe?
Does the Trump administration have a point, you know, that the U.S. should scale back its support around the world? So I think that's a very broad question. So to what extent do we as humans have the responsibility to help other humans? This was perhaps one of the most important global health fights of our time. And it was one of the most shining examples of American soft power. One of the greatest public health victories, you know, on par with the eradication of smallpox.
I think one of the things that Mary's story also has shown us is that when you give somebody just a tiny little bit of help, like a little bit of respite. They can go a long way towards making their community and their country a better place. So Mary had this little stipend and a little bit of food, and as a result of that, She was able to set up an organization that helped 700 people. She actually ran for a local office as a local counselor in the last election, and she lost.
But she is out there organizing demonstrations, teaching people how to fight for their rights. trained herself as a paralegal. And the way that she was able to do that was with just a tiny little bit of help from the American government. And Kenya was well on its way to getting the disease under control. And now it might not be. Cross borders. Sex workers are going to sleep with tourists. People whose medications are interrupted might develop.
drug-resistant strains of the disease and pass that on. And those strains are much, much more expensive to treat. So the problem is that when you have a deadly disease, it does threaten everyone and it doesn't respect borders. And that's what Mary told me about. HIV is not for African only HIV is not for Kenya only you should understand that Catherine, thank you so much for joining us. Thank you. Catherine Horrell is a Nairobi correspondent for The Post.
That's it for Post Reports. Thanks for listening. If you're looking for the latest updates on the big news of the day, check out our morning news briefing, The Seven. We bring you the seven stories you need to know about every weekday morning by 7 a.m. You can listen to it wherever you listen to podcasts. Today's show was produced by Alana Gordon. It was mixed by Sean Carter and edited by Lucy Perkins.
also to Jesse Mesner-Hage and Jen Amer. I'm Colby Ickowitz. We'll be back tomorrow with more stories from The Washington Post. Okay, real talk. We're all kind of hooked on our phones. It's full of shiny apps designed to keep your attention captive forever. But there's real-life stuff to do other than scrolling, and I'm here to help. I'm Christina Quinn, the host of Try This, a podcast from... we're learning to tame the dopamine beast.