COPPERBELT PROVINCE — Three brothers, Joseph, 17, Gift, 15, and Alumbwe, 12, are living in a rain-damaged home in Zambia's Copperbelt Province after their parents died from AIDS. Their parents passed away approximately one year after losing access to HIV medication, which occurred due to reductions in U.S. foreign aid.

Joseph, Gift, and Alumbwe share one blanket and sleep on a bamboo mat on the floor. Rainwater enters their home through holes in the roof. The brothers sold their mattresses and other household items to generate income and finance transportation to a hospital for their parents. "We started selling things in the house. Whoever wanted to buy a mattress, we would sell. Whoever wanted pots, we would sell." Joseph said.

Their mother died in January, and their father died in February. Both parents had been living with HIV and previously took daily medications to manage their condition. Local programs that delivered HIV medication to the family's area stopped operations during the funding cuts. The family's residence is located a three- to four-hour walking distance from the nearest hospital. The mother relocated to her sisters' home and died there. "The house is not okay. Even though we live here it's only because we have nowhere else to go." Joseph said.

Billiance Chondwe, a reverend in Zambia, is assisting 25 orphaned children in his community. Chondwe said U.S. government-funded HIV clinics in his area ceased operations after federal aid reductions. "In the rural remote areas, there used to be mobile clinics and nowadays it is not there." Chondwe said. "There is a lot of stress and pressure. They don't have enough food. Where they are staying is not suitable." Chondwe added. Community health workers previously compensated by a U.S. aid program delivered HIV medications to the family's residence.

Eric Goosby, a professor of medicine at the University of California, San Francisco, served as the second director of PEPFAR from 2009 to 2014. PEPFAR, established during the George W. Bush administration, developed a care system that assisted approximately 6 million children annually. This care system funded local adults to care for children within their communities, and included provisions for their education, nutrition, and medical care. "It's a largely unsung story for PEPFAR and it's the only non-traditional medical intervention PEPFAR heavily funded." Goosby said. He also stated, "The community around them rejected them because the stigma for HIV was so severe."