Pediatric AIDS Foundation
A mother and her son during a doctor's appointment at a health center funded by USAID in Maseru, Lesotho, July 2017.
Midway through President Donald Trump’s recent address to Congress, while listing initiatives he views as “appalling waste,” the President referenced “eight million dollars to promote LGBTQI+ in the African nation of Lesotho, which nobody has ever heard of.” He even mispronounced Lesotho.
Vice President J.D. Vance and House Speaker Mike Johnson, seated behind the President, smirked, shook their heads, and laughed. A chorus of Republican Congresspeople responded in turn.
As a nurse and public health researcher who has witnessed firsthand the value of U.S.-sponsored programs in Lesotho—programs now threatened by Trump’s blanket cuts to foreign aid—I did not see anything to laugh about.
I first visited Lesotho in September 2016 as a twenty-two-year-old Fulbright grantee. I was drawn to Lesotho by its rugged beauty, rich culture, and unfortunate distinction as the nation with the world’s lowest life expectancy.
I came with little: two bags, one pre-existing social connection, and near-zero fluency in the local language. Still, the people of Lesotho welcomed me with open arms. Strangers walked me to work, gently correcting my pronunciation as I clumsily expanded my Sesotho vocabulary. Coworkers indulged my curiosity, teased me for my coffee consumption, and asked twice daily if I was eating enough.
Friends invited me to pick-up soccer games, weddings, and family reunions. There were some hard moments, but far more often, I felt gratitude for the life-altering impacts of America’s then-seventy-year-old investment in fostering mutual understanding through the Fulbright program.
Through my nine-month Fulbright and a subsequent year-long stint with Partners In Health, I traveled to thirty health centers to help examine how changes to leadership, infrastructure, staffing, and supply chains impacted health care access across Lesotho. Within remote clinics financed by U.S. grants, I spoke with nurses, educated and employed through the President’s Emergency Plan For AIDS Relief, who served as the only source of health care in a three-hour walking radius.
I spoke with village health workers who—for $1 per day—led educational talks, conducted health screenings, and accompanied sick patients over mountains and rivers to treatment. I spoke with patients who described how sustained investments in clinics, nurses, and essential medicines made health care worth seeking.
“When I became pregnant,” one mother told me, “I was not sure when to start coming to the health center. My three prior deliveries were at home. This time, I came to the health center because otherwise, there would be nobody to manage complications.”
Lesotho has the world’s second-highest prevalence of HIV, second-highest tuberculosis incidence, and ninth-highest maternal mortality ratio. Its health care workers save lives. Through sun and snow, they deliver babies, administer vaccines, and treat conditions from heart failure to tuberculosis. In just fifteen years, their efforts have helped Lesotho achieve massive decreases in HIV incidence and a ten-year increase in life expectancy.
Americans should be proud of our contributions to this effort. Since it was established by George W. Bush in 2003, the President’s Emergency Plan For AIDS Relief (PEPFAR) has saved more than twenty million lives. Yet in 2024, across fifty-five countries with PEPFAR-funded programs, the initiative accounted for less than 0.1 percent of U.S. spending.
The new administration’s cuts imperil this progress. While a March 5 Supreme Court ruling ordered the administration to release appropriated funds, Trump’s sweeping ninety-day aid suspension and defiance of prior court orders have already caused harm.
In Lesotho, where nearly one in four adults lives with HIV, funding cuts mean widespread staffing layoffs and terminated treatment. They mean fewer girls in school. They mean delayed diagnoses, broken linkages to care, and preventable deaths. For key populations at elevated risk of HIV exposure (including LGBTQ+ individuals and the textile workers who produce Trump-branded apparel), they mean reduced safety, more discrimination, and poorer health.
When Trump speaks of Lesotho, he does so without interest in the staff, supplies, or diplomatic partnerships that U.S. investments have secured. He does so with open disdain for the Americans whose life’s work he upends.
Most devastatingly, he does so without compassion for the millions who will suffer—unnecessarily—as sacrifices to a mispronounced punchline.
This column was produced for Progressive Perspectives, a project of The Progressive magazine, and distributed by Tribune News Service.