Harerimana Ismail hasn't had a paycheck since the beginning of last year. He's kept working nonetheless.
When the Trump Administration paused foreign aid and issued stop work orders in January of 2025, almost all U.S. foreign aid projects were halted. That included the termination of Ismail's work as a community health worker at the Kabale Regional Referral Hospital in southwestern Uganda, where his salary – roughly $50 a month – was paid for by a U.S. grant. He'd been a community health worker for eight years.
But he's kept going door-to-door to make sure that children who have HIV are still taking their medications, connected to medical care and feeling supported.
"There is not any stipend or salary that I'm paid," says Ismail, 32, who himself contracted HIV at birth from his mother. "It's just because I understand the pain young people living with HIV pass through — that's why I remain."
Without an income, he's surviving primarily on the vegetables he grows in his garden. He sells Irish potatoes to pay his rent and says he's lost 15 pounds this past year.
New data suggests the work that Ismail — and others like him — have been doing to keep people on HIV treatment has had a big impact.
So much so that the forecasts warning of a major collapse in HIV/AIDS treatment efforts, after foreign aid cuts threw programs into turmoil, appear to have been averted — at least for now. Preliminary figures from the U.S. government suggest global HIV treatment levels are at roughly the same level as before the disruptions. With the U.S. supporting more than 20 million people on HIV treatment, the number dipped by only 100,000 people between the end of the 2024 reporting period and a year later.
"The most severe outcomes that we were concerned about haven't come to pass," says Jeff Imai-Eaton, an associate professor of epidemiology at the Harvard T.H. Chan School of Public Health.
That's good news. But there's also bad news in the world of HIV.
A brief flash of data
For decades, the U.S. has played a leading role in the worldwide fight against HIV/AIDS, pouring well over $110 billion into the effort and saving 26 million lives. It has also provided some of the best data on the disease, tracking everything from how many people in various age brackets and countries are tested for HIV to how many people are on medications to suppress the virus. The goal was to make sure the programs are on target to hit their specific goals.
"It really was a gold standard for collecting data on a regular basis and sharing it transparently — and then using that data to really inform decision making," explains Ramona Godbole, the former deputy director of policy, planning and programs at the now-defunct U.S. Agency for International Development. In that job, she helped oversee the global health data hub.
This past year, as foreign aid has been slashed and many HIV programs upended, the U.S. government stopped reporting the data.
"It has really been a black box. There has been no new data released," Godbole says.
But a handful of weeks ago, preliminary data on the U.S.'s HIV work briefly appeared on a government website, before it was taken down. The State Department declined to comment on why the data was removed. Even though the data has not yet been officially released and the numbers could change, experts say that brief flash of numbers broadly matches what other organizations are finding.
"It complements quite well the data that we've received [from countries]," says Mary Mahy, director of data and evidence at The Joint United Nations Programme on HIV and AIDS or UNAIDS.
As HIV/AIDS specialists pore over the latest figures to get a sense of what all the disruptions have amounted to, there is a realization: At least when it comes to the number of people on HIV treatment, the dire warnings of a tremendous dropoff didn't come to pass.
"In a better place"
Early last year, Charles Kenny — a senior fellow at the Center for Global Development, a Washington, D.C. think tank — tried to estimate to the best of his ability the impact of the aid cuts. He was among a number of experts to produce dire warnings about the impact. That preliminary flash of government figures, he says, gives him hope that U.S. support for people on HIV treatment is stronger than he'd projected.
"If this data is right, we are in a better place than I thought we would be, even though we're still in a really bad place," says Kenny, who wrote a blog post analyzing the data.
In a statement to NPR, the State Department confirmed that treatment levels at the end of the 2025 reporting period were at roughly the same levels as a year before. While the data suggests treatment levels dropped off in March 2025 — dipping by 23% — they then rebounded and were only down by 2% come September.
The State Department said that "any perceived decline in treatment numbers was due to temporary reporting challenges, not actual disruptions in care." Further, the statement said the "release of data has been delayed due to reporting issues. We will only share data when we are confident it is accurate…We expect to resume regular data reporting going forward."
Imai-Eaton's sense is that the treatment numbers rebounded not because the scary predictions were wrong but because of a global spirit of cooperation. The potential loss of life prompted action around the world at three levels.
Three types of action
The first thing that helped boost treatment levels: The Trump Administration restarted some programs deemed lifesaving. life-saving.
"The U.S. government did realize the potential impact of the stop work order," explains Mahy. "People that were in place at the [HIV/AIDS program] there in Washington were able to communicate: 'We need to get the drugs to countries and then allow the countries to distribute.' "
Second, countries that had been receiving the aid stepped in to fill whatever gaps they could. "The efforts by Ministries of Health to reprioritize and sustain services was pretty heroic," says Imai-Eaton.
And the third factor? It's people like Ismail in Uganda, who persevered despite the obstacles – borrowing a bike, for example, to check on children in the surrounding hills since it's too far to walk and he can no longer afford to hire a motorcycle, called a boda boda, the way he did when he was employed.
Individuals and "communities just saying: 'It doesn't matter if we don't get paid, we need to reach out to these people and make sure that they're getting their medications," says Mahy. Several other HIV specialists interviewed for this story pointed to the selflessness of community health workers and other frontline medical professionals as a key reason that treatment levels have not dropped off as much as some anticipated.
"Providing the absolute bare minimum"
Even though treatment levels are high, a deeper dive into the world of HIV gives specialists cause for concern. For example, the number of people able to get HIV testing and counseling thanks to U.S. support dropped from more than 80 million at the end of the 2024 reporting period to just under 70 million a year later.
These HIV advocates say the quality of the treatment services have suffered and many of the related HIV programs — such as prevention programs and peer support groups — have shut down.
Ismail explains that some patients he works with "have expired drugs" because of supply chain disruptions. And many patients face long wait times at hospitals where they go to get their medications — from 4 to 9 hours, he says.
And there's more that's gone by the wayside in this new aid era. The distribution of condoms to prevent HIV has dwindled, for example, according to Imai-Eaton. The same goes for efforts to educate, counsel and care for the highest-risk populations — like sex workers and men who have sex with men.
Dr. Caspian Chouraya, who oversees work in a dozen countries for the Elizabeth Glaser Pediatric AIDS Foundation says many support groups for teenagers with HIV have ended because of funding cuts. Similarly, the money that paid for cell phone minutes so clinic employees could call patients and remind them about upcoming appointments and medication refills has dried up.
Emily Bass, who wrote the book To End A Plague on the U.S. response to HIV/AIDS, has been tracking the current situation closely. Events of the past year, she says, raise fundamental questions about the U.S. response to HIV/AIDS.
"The entire treatment ecosystem was sort of shredded," she says. "And then it becomes a question of like: Are we happy with providing the absolute bare minimum?"
"She died in my hands"
Then there's the matter of new HIV cases and deaths in the HIV positive population: Have the aid cuts had an impact? The State Department in its statement to NPR said any suggestion of "widespread treatment loss — and the resulting claims of 'lives lost' — is inaccurate, misleading, and irresponsible." Experts like Kenny and Mahy, say it's too early for the data to show definitively if there is an uptick in the spread of HIV or deaths from AIDS.
Ismail says he has a sense of what the data will eventually show.
"I was seeing very many people dying," he says of the past year.
His mind goes to a cheery 14-year-old girl, who wanted to be a nurse and always greeteding him with a hug. As a community health worker, he used to bring her medications to her but she lived too far away for him to check on her when he lost the money that paid for his transportation. She And she didn't have transportation to get to the hospital, so she went without her HIV medications.
Then, this past June, her extended family managed to scrape together enough money to get her to Ismail's village to go to the hospital. "She reached the hospital and she died in my hands — a 14-year-old," Ismail says.
He says the girl's death devastated him and helped motivate him to keep going door-to-door.
However, Ismail admits he won't be able to keep working without pay forever. He says he's trying to reach as many of his former patients as he can before it's too late to save them and before he has to face the hard fact that he can't live indefinitely off his garden's harvest indefinitely.
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