Born Negative: How U.S. Funding Protected a Lesotho Grandson from His Family’s HIV Struggle
Thirteen-year-old Sephamandla Makhetha rests his chin in his hand, carefree, as if stroking an imaginary beard. His face is serious as he says, with quiet certainty: “It feels good to be young and living without HIV”, writes Pascalinah Kabi.
He understands the weight of those words. HIV, he knows, “is a disease with no cure.”
It is the virus that has shaped his family’s story—his grandmother, Maphatšoane Makhetha, and his mother, Palesa Makhetha, have lived with it for decades, long before Sephamandla was born.
His grandmother credits Sephamandla’s HIV-negative status to his mother’s unwavering commitment to antenatal care, strictly following every medical recommendation to ensure the virus was never passed on.
“She was told to take her ARV medications because not doing so would put Sephamandla’s life at risk of infection.
The baby was also given medication after birth, and he was tested repeatedly until he was finally declared HIV-free,” Maphatšoane told AfricaBrief on July 25, 2025, from her home in Mphaki, Quthing district.
This success was made possible through foreign aid funding from the American people, which enabled Lesotho—and many other countries—to implement the prevention of mother-to-child transmission (PMTCT) program.
Maphatšoane says two more of her grandchildren have also benefited from the PMTCT program.
“I am lucky to have three grandchildren born to HIV-positive mothers who are all HIV-negative. It is a wonderful feeling, because it is painful to see small children taking medication—it really hurts,” Maphatšoane said.
She added, “When a small child starts taking meds, it feels as though they are being stigmatised.”
Children walking free from HIV
In the small village of Liphakoeng, tucked between the brown mountains that cut across Mphaki in Quthing district, 61-year-old ‘Mantaoleng Bulane began her journey as a Village Health Worker back in October 1988.
“Back then, when HIV first came, people didn’t know it could be prevented from passing from mother to child. Children died alongside their mothers,” Bulane recalled in an interview with AfricaBrief on July 25, 2025.
That afternoon, the sky hung wide and heavy, nearly swallowed by thick white clouds with streaks of grey bleeding through like bruises—an atmosphere that seemed to mirror the gravity of her words.
A turning point came in 2003, when the U.S. government launched the President’s Emergency Plan for AIDS Relief (PEPFAR). Since then, it has invested over $110 billion in the global HIV/AIDS response—the largest commitment by any nation to tackle a single disease.
The US government says the program has saved 26 million lives, prevented millions of new infections, and accelerated progress toward controlling the pandemic in more than 50 countries.
In Lesotho, the change was equally profound.
“Back then, there was no protection. No one knew their status, so infections were passed unknowingly. But now, most women deliver at clinics, not at home,” Bulane explained.
Today, she serves about 150 households in Mphaki. Asked how many babies were born HIV-negative since the introduction of PEPFAR’s prevention of mother-to-child transmission (PMTCT) program in Lesotho, she answered without hesitation:
“From around 2000, I can count about 15 children who were born HIV-negative even though their parents were positive. You could see it from our records—they were many.”
She says this progress is thanks to the expansion of HIV prevention programmes that not only helped people learn their status but also gave mothers the power to protect their babies.
For her, the impact is not abstract—it lives in the face of 13-year-old Sephamandla, one of the children born HIV-free through the PMTCT programme.
“Sephamandla is one of the children born HIV-free to an HIV-positive mother. He is healthy, full of life, and a living testament to the success of preventing mother-to-child transmission. Every time I see children like him walking, thriving, and HIV-free, my heart fills with joy—it is proof that our efforts truly make a difference,” Bulane said.
Sephamandla is a Grade 7 learner at Tšitsong Primary School in Mphaki, Quthing. His favourite subject is social science, where he learns “how we can protect ourselves.”
He talks about lessons that go beyond textbooks—how to use condoms and other measures to prevent sexually transmitted infections like HIV. “They tell us, ‘Say no to unprotected sex,’ because you could get HIV/AIDS,” he explains.
“I do fear it,” Sephamandla admits quietly, a seriousness far beyond his years. Living in a family touched by HIV has made the risk real to him, and every lesson about prevention feels like a shield against a virus he has seen affect the people he loves.
He lost his aunt, Maphatšoane’s daughter-in-law, to AIDS-related illnesses and watched his mother endure months of the relentless toll of HIV co-morbidity—multidrug-resistant tuberculosis.
A stroke of a pen took it all away
In January 2025, U.S. President Donald Trump’s decision to cut all foreign aid funding threatened to undo decades of progress in HIV prevention in Lesotho. “It’s painful. It’s like we are going backward,” Bulane told AfricaBrief.
She added, “I worry that children and mothers will die because of lack of support. We are struggling even as community health workers. We fear for our lives and our children’s lives.”
Her fears were grounded in reality. Health facilities such as Nazareth in Maseru and Lejone in Leribe already felt the impacts of the aid cuts.
At Nazareth Health Centre, the absence of HIV counsellors has hampered testing for pregnant mothers, threatening the prevention of mother-to-child transmission.
In Lejone Health Centre, HIV testing and counselling were limited to just Tuesdays and Thursdays. As of September 2, 2025, the situation there remained unchanged.
This came despite the eventual restoration of $6 million in PEPFAR funding, following a rare push by congressional Republicans in mid-July 2025. Republican lawmakers to rescind previously authorised funding for federal programs.
Mangose Sithole works at the Ministry of Health’s Family Division. On September 2, 2025, she told AfricaBrief: “I have heard about the issues regarding U.S. funding for PMTCT, but unfortunately, I do not have complete information on the funding to Lesotho. What I can suggest is that you speak directly with the partners who support PMTCT.”
Sithole said these partners include USAID, Centre for Disease Control (CDC), PEPFAR, Baylor, and mothers2mothers. She explained that the purpose of such interviews would be to determine how much funding was requested and how much has been disbursed.
“I know they will support me with this and that,” she said, “but for the nitty-gritty details, you should talk to the organisations that receive funding directly from the U.S. government.”
US embassy comment
On September 5 2025, the US Embassy spokesperson said the $6 million initial funding provided in July 2025 will continue lifesaving HIV care and treatment services in the four districts of Maseru, Mohale's Hoek, Mafeteng, and Thaba-Tseka.
‘FHI360 has already begun mobilising resources, recruiting staff, and engaging with the Ministry of Health and other partners with whom they are collaborating on program implementation,” read the emailed responses.
It added: “This initiative, under the EpiC program, aligns with U.S. priorities under the management of the Global Health Security and Diplomacy (GHSD) office within the Department of State. It will continue to implement critical PEPFAR strategic objectives, including: Prevention of mother-to-child transmission (PMTCT), including access to necessary commodities and test kits, antiretroviral medications, and pre-exposure prophylaxis (PrEP) for pregnant and breastfeeding women.”
The funding will also be used in health systems strengthening through technical support aimed at advancing PEPFAR’s HIV epidemic control goals, with a focus on monitoring and evaluation at the site and district levels, commodity security, client-level laboratory monitoring, clinical management, and quality improvement.
Additional reporting by Limpho Sello
This investigation was produced in partnership with the Pulitzer Centre.