Health Minister Confident Lesotho Can Manage Without US Funding, but Jobs Are Already Being Lost

• Lesotho’s Minister of Health Selibe Mochoboroane says the government will only need to spend R181.2-million more if the US completely cuts R1.2-billion in HIV funding.
• Mochoboroane said the US approach is too expensive and cheaper ways will have to be found.
• But at least 805 health workers have already lost their jobs, testing services are no longer widely available, and there are fears that ARV medicines may be disrupted.

Lesotho’s Minister of Health Selibe Mochoboroane claims the government will need R181-million to cover the shortfall if the US government decides to cut R1.2-billion in HIV funding.

“In the last financial year, the US supported Lesotho with R1.4-billion in its fight against HIV,” Mochoboarane said. He said a further R1.2-billion in funding was expected for 2025, but this was now uncertain due to a 90-day review of US financial aid announced by President Donald Trump in February.

Trump’s funding cuts have, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS), already terminated or paused 72% of the support Lesotho receives from the Presidential’s Emergency Plan for Aids Relief (PEPFAR), causing 804 health workers to lose their jobs.

Mochoboroane told Lesotho’s Parliament on Friday that PEPFAR’s approach is “too expensive” and that the government must “adopt methods that align with our available resources”.

He said the government is confident it will still be able to meet its 95-95-95 targets by 2030. The targets, driven by the Joint United Nations Programme on HIV/AIDS (UNAIDS), are to have 95% of people living with HIV aware of their status, 95% of those diagnosed with HIV on ARV treatment, and 95% of those on ARV treatment virally suppressed.

Mochoboroane did, however, acknowledge that funding cuts will affect the availability of medicine and human resources. He said that government-employed workers are unable to fill the gap. “We risk burnout. The only solution is to absorb affected workers under the government payroll, but our current budget does not cover them,” he said.

US HIV funding primarily comes through the Centers for Disease Control (CDC) and USAID. PEPFAR-funded programmes through the CDC are still active, but those funded through USAID were all shut down on 27 February.

Mochobroane said that if all US funding is completely cut after the 90-day review period ordered by Trump, the health department will need R181.2-million in addition to its current R2.4-billion health budget to cover the shortfall. If only USAID funding is cut and CDC funding continues, the country would need R69-million to continue testing services. Contingency funds may be used to fund the gap, Mochoborane said.

But the government may be underestimating the impact that US funding cuts will have on HIV testing and care.

On the streets of Maseru, the effects of funding cuts are already visible. Many of the US-funded non-profit organisations that made HIV testing services widely available have now shut down and free HIV testing is only available at government facilities. For those who live far from these facilities, testing services are inaccessible.

Maseru resident Poloko Mokhele purchased an HIV self-test kit for M55 (R55) from a pharmacy. “I usually collect self-test kits from Sefika Resource Centre, but when I sent someone to fetch one, they found a notice saying that services were suspended,” Mokhele explained.

He attempted to get a kit from another organisation at Kingsway Mall but found it closed as well. “Before these funding issues, these services were easily available in tents along main roads or specific locations. Now, accessing them has become difficult. If testing services are delayed, people may unknowingly spread HIV,” he warned.

He further explained the inconvenience: “People say we can still get test kits at Lesotho Planned Parenthood Association [not US-funded] and government health facilities, but if I work near Sefika Resource Centre, I don’t have time to travel that far. I cannot take a day off just to get a test kit from a public facility. If I had unprotected sex on Sunday and wanted to test on Monday but couldn’t, I might unknowingly transmit the virus to someone else the following weekend. That is the real danger of these disruptions.”

USAID’s Sustaining Epidemic Control through Unified Prevention (SECURE) program, which was to provide HIV prevention, testing and treatment services, was among those terminated. The program was supposed to receive $35 million (R640-million) over five years.

Executive Director for the Lesotho Council of NGOs, Sekonyela Mapetja said he is sceptical of the government’s ability to fill the gap left by USAID. He is concerned that the budget for the 2025/26 financial year, yet to be passed by Parliament, does not make provision for the US funding cuts.

Fears of ARV shortages

The World Health Organisation (WHO) last week listed Lesotho among several African countries experiencing disruptions in antiretroviral therapy (ARVs) services, raising concerns about potential stockouts.

“We are particularly worried about Haiti, Kenya, Lesotho, South Sudan, Burkina Faso, Mali, Nigeria, and Ukraine, where ARV disruptions could have severe consequences,” WHO officials stated at a press conference last week.

Responding to GroundUp’s questions, WHO spokesperson Christian Lindmeier said: “WHO noted that eight countries – among them Lesotho – have substantial disruptions to antiretroviral therapy (ARVs), meaning disruptions to supplies, services or both. Some countries have supplies but no services, and if people can’t access the therapy, it’s just as bad as not having the drugs at all.”

“From the WHO survey, Lesotho is not facing an immediate stockout of ARVs; however, the country did report disruptions in the provision of HIV services, including: access to HIV testing, initiation of new ARV treatment and continuation of stablised ARV treatment, as of early March,” Lindmeier added.

Broader impact of funding cuts

Minister of Finance Retšelisitsoe Matlanyane told Parliament on Friday that Trump’s order for a 90-day review of all USAID funding came at a critical time in Lesotho’s budgeting process. “The financial implications extend beyond health, affecting various government sectors dependent on external funding,” she said.

“The government has decided to finalise the budget while awaiting the outcome of the 90-day review period, which ends on 20 April. We continue to receive updates from the US Embassy in Maseru but will act based on final decisions,” Matlanyane added.

She urged government ministries to assess their vulnerabilities and formulate strategies to mitigate the funding crisis.

“The impact is too huge to ignore. We have found that these Executive Orders affect all departments of government, as we rely on funding in different areas.”

© 2025 GroundUp. This article is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.

You may republish this article, so long as you credit the authors and GroundUp, and do not change the text. Please include a link back to the original article.

We put an invisible pixel in the article so that we can count traffic to republishers. All analytics tools are solely on our servers. We do not give our logs to any third party. Logs are deleted after two weeks. We do not use any IP address identifying information except to count regional traffic. We are solely interested in counting hits, not tracking users. If you republish, please do not delete the invisible pixel.