THE health clinic where Alice Okwirry collects her HIV medication in Kenya’s capital Nairobi has been rationing supplies of antiretrovirals to one-month refills since the US government froze foreign aid.

On the outskirts of the city, meanwhile, millions of life-saving doses sit on the shelves of a warehouse, unused and unreachable. The clinic is a half hour’s drive from the warehouse, but for Okwirry, they may as well be an ocean apart.

Without US funding, distribution from the warehouse, which stocks all US government-donated HIV medicine to Kenya, has ceased, leaving supplies of some drugs worryingly low, according to a former USAID official and a health official in Kenya.

The 90-day foreign aid freeze, ordered by US President Donald Trump after taking office on January 20, has upended the global supply chain for medical products to fight HIV and other diseases. It is also blocking the distribution of drugs that long ago reached their destination countries.

“I was just seeing death now coming,” said 50-year-old Okwirry, who was diagnosed with HIV in 2008 and has a 15-year-old daughter, Chichi, who is also HIV-positive. Okwirry used to receive six-month supplies of ARVs from the clinic but now can only get one month. “I told Chichi: What about if you hear the drugs are doomed?” Okwirry said, growing emotional. “She told me: Mom, I’ll be leaning on you.”

The US State Department issued a waiver last month exempting funding for HIV treatment from the freeze. But the USAID payments system in Kenya is down after the cuts, meaning contractors who implement the programmes cannot be paid, said Mackenzie Knowles-Coursin, who was the deputy head of communications for USAID, East Africa, until resigning on February 3 in protest at the dismantling of the agency.

“Projects are left wondering: Well, how am I going to resume activities if you’re not paying me money?” he said. “The waivers that have been given are really waivers on paper.”

In Kenya, officials in Washington have not authorised the release of money required to distribute the $34 million (R619m) worth of medicine and equipment at the warehouse, he said.

According to a Kenyan government document seen by Reuters, about $10m is needed for that distribution. The Mission for Essential Drugs and Supplies, the Christian charity that runs the warehouse, supplies drugs to some 2 000 clinics nationwide, its website says.

Here, in South Africa, for the past two months, Elsie has been receiving daily calls from desperate children surviving on HIV treatment whom she is not allowed to help.

The lively 45-year-old aid worker, who preferred not to give her real name, used to spend her days visiting hundreds of HIV patients in South Africa’s Msogwaba township around 300km east of Johannesburg.

But since US President Donald Trump slashed US foreign aid funding in late January, Elsie has been forced to stay at home, forbidden from contacting her patients.

“I was supporting 380 kids, making sure each and every kid is taking his medication, is virally suppressed, and each and every kid is not being discriminated against or violated,” she recalled. “We teach them to accept themselves as they are, to know they are loved. I take them as my own children.”

The non-governmental organisation she worked for, which she did not want to identify in case of repercussions, supported almost 100 000 people per year, including many HIV-positive children, orphans, and child-headed households.

USAID provided the group with more than $3m a year in funding.

Elsie was one of upwards of 100 community health workers tasked with monitoring the children, checking in on their well-being, and facilitating access to the lifelong treatment they require to stay healthy and avoid transmitting the virus.

Now unable to visit them, she said she fears the worst.

“My fear is that they won’t take their medication,” she sighs. Some children have gone missing since the programme ended, she says. She is worried that others might miss their hospital appointments. “We know each and every one of those kids and their problems. Some of them won’t survive.”

South Africa has one of the highest rates of HIV/Aids in the world, with around 13% of the population—or 7.8 million people—living with the virus, according to government data.

In 2023, there were about 640 000 children orphaned by the virus in the country.

The government has assured the cuts will not affect its rollout of antiretrovirals (ARVs). In February, it launched a campaign to extend the lifesaving treatment, which already reaches 5.9m patients, to 1.1m additional people by the end of the year.

“The country has got capacity to provide… HIV treatment to people living with HIV because almost 90% of the current treatment is purchased through the fiscus/government budget,” health department spokesperson Foster Mohale told AFP.

But the US President’s Emergency Plan for Aids Relief (Pepfar)—among those hit by the funding cuts—supported numerous programmes focusing on prevention, counselling, and monitoring and amounted to 17% of South Africa’s overall HIV response.

“It’s about much more than medicine,” said Sibongile Tshabalala-Madhlala, who chairs the Treatment Action Campaign, a leading HIV advocacy organisation. “It’s about a person finding a friendly healthcare worker at the facility. It’s about understanding the challenges of people living with HIV and their needs. It’s about prevention and keeping people in care.”

The funding cuts will severely impact human resources in already understaffed and overcrowded hospitals, she fears, including by extending waiting periods. The Pepfar cuts alone meant 15 000 workers lost their jobs, Health Minister Aaron Motsoaledi has said.

A study published in the Annals of Internal Medicine in February suggested that cutting all Pepfar funding to South Africa could lead to more than 600 000 additional HIV-related deaths over the next decade.

While the Department of Health said this figure was merely “assumptions”, Tshabalala-Madhlala said she believes “people will die”. “People won’t be able to miss work to get their medication. Some are already sharing ARVs. With this disruption, we will see a rise in infection rates and more HIV-related deaths,” she said.

Sitting in his mother’s house on a dirt road in Msogwaba, a scrawny 17-year-old holds his head in his hands. The teenager, who Elsie believes shows signs of autism, is worrying about his next appointment.

Previously, Elsie would accompany him to the clinic. “She helped him a lot whenever he was struggling,” sighed his mother, who cannot afford to take time off work to accompany her son. “I feel that we’ve been abandoned.” Elsie said she felt the same. “I was forced to abandon them -- they really trusted me.”