As he does every three months, Sibusiso traveled on Wednesday morning to a clinic in the capital of Eswatini, a tiny southern African nation, to get a refill of the H.I.V. medication he needs to save his life. When he arrived, the door was locked and about 20 other patients stood outside, baffled that the clinic was closed.
Sibusiso, 39 and unemployed, had heard rumors that President Trump was pulling funding for the program that supported his treatment. Now, though, he learned the reality: The Trump administration had ordered a halt to the President’s Emergency Plan for AIDS Relief, or PEPFAR, one of America’s most consequential aid programs in Africa.
The abrupt pause of a $6.5 billion program established by former President George W. Bush and credited with saving the lives of tens of millions of people sent patients, clinicians, and public health advocates across Africa into a panic. Many feared a return to some of the darkest days on the continent, when H.I.V. spread rapidly and a diagnosis was akin to a death sentence.
As Sibusiso stood outside the clinic, he feared he could be next. He had taken the last of his antiretroviral medication that morning. And even though the Trump administration had backtracked, suddenly announcing on Tuesday that lifesaving medications and treatments could continue to be distributed, the clinic remained shuttered in the confusion.
Sibusiso, standing outside, had no idea where or when he could get more medicine.
I’m now thinking of dying, Sibusiso, who requested that only his first name be used to protect his privacy. What am I going to do without this treatment?
The Trump administration has said that foreign assistance programs will be paused for three months as it reviews how money is being spent. If the administration decides to end PEPFAR, it could lead to 600,000 deaths over the next decade in South Africa alone, where the program has its largest number of beneficiaries, according to a study.
The next 90 days are looking so dystopian, said Nozizwe Ntsesang, the chief executive of a leading gay rights advocacy group in Botswana.
Across South Africa and other countries in the region, fear and uncertainty are palpable. Some African leaders had shared optimism and excitement about a second Trump term. But now, one of his first moves appeared to put lives at risk.
I’m scared, said a 19-year-old South African college student who was born with H.I.V. People will die. It’s going back to the ’90s where people did not have enough medication to treat the disease.
PEPFAR does not provide medication for the South African health system, but it does employ around 13,000 medical professionals, from doctors to community health workers, who are responsible for ensuring that people are tested and seek proper treatment. Virtually all of those employees were ordered to stop working after the Trump administration froze foreign aid programs, according to health care advocates.
The staff shortages, health workers and rights groups said, led to much larger crowds at public clinics in South Africa, where roughly eight million people are living with H.I.V. and 5.7 million receive treatment.
Amid the chaos of the freeze and the Trump administration’s backpedaling, many clinics remained shuttered on Wednesday, with medical workers unsure about the new rules and patients frantic to secure their medication.
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