In a small, dimly lit room on the outskirts of Monrovia, Johnson (not his real name), who has lived with HIV for 24 years, stares at his dwindling supply of antiretroviral medication. With just five months’ worth of treatment left, he and thousands of others in Liberia now face an uncertain future following the abrupt suspension of U.S. aid.
“If the government doesn’t step in with a solution, some of us may not last beyond the next few years,” Johnson said grimly.
The aid freeze, part of a broader U.S. pause in assistance to Liberia, has sent shockwaves through the country’s already fragile healthcare system. The impact has been particularly devastating for HIV/AIDS patients who rely heavily on American support through the President’s Emergency Plan for AIDS Relief (PEPFAR). Since the end of Liberia’s civil war in 2003, U.S. funding has been the backbone of the country’s HIV/AIDS programs, supporting 70 treatment centers across all 15 counties.
At ELWA Hospital, a primary HIV treatment facility, the consequences were immediate. By early February, the hospital reported severe shortages of crucial medications, especially for infants and children, while viral load testing and peer counseling programs came to a grinding halt.
The crisis threatens to erase two decades of progress in HIV/AIDS treatment. Liberia has an estimated 39,000 people living with HIV, and the sudden funding shortfall could lead to treatment interruptions, drug resistance, and an uptick in new infections. “When you were supposed to get six months of medication, now you only receive three,” Johnson explained. “Without proper treatment, the virus becomes more transmissible.”
The impact extends beyond medication shortages. Organizations like FHI 360, which implements USAID’s programs, have suspended operations, leaving program managers, healthcare workers, and peer educators unemployed. The disruption could set off a chain reaction, leading to increased HIV transmission among vulnerable groups such as sex workers and young people.
Yet, amid this crisis, some argue that the situation exposes a deeper issue: Liberia’s overreliance on foreign aid for essential services. Gabriel Starks, Executive Director of the Starks Foundation and a member of Liberia’s Global Fund board, sees the suspension as a harsh wake-up call.
“Donald Trump has no responsibility to us. We never elected Donald Trump,” Starks said, underscoring the need for Liberia to take control of its healthcare system. “We have gold, diamonds, and other natural resources, yet we still depend on handouts.”
Starks pointed to Burkina Faso as a model of self-sufficiency, where recent policy changes have prioritized domestic funding for social services. He estimates that Liberia would need approximately $14 million annually to sustain its HIV/AIDS programs, with the cost of medication alone ranging from $1.3 to $1.4 million, a figure he believes the Liberian government could manage with better budget prioritization.
However, for those living with HIV, political rhetoric offers little comfort. Treatment centers are already struggling, with healthcare workers forced to ration medication and essential services. Some fear that without intervention, the crisis could spiral into an epidemic-level resurgence of HIV infections in the country.
The government’s response has been largely inadequate. While some officials claim to be exploring alternative funding options, there has been little concrete action. Civil society groups and activists argue that Liberia’s leaders must do more than just appeal for the aid suspension to be lifted. Instead, they must demonstrate a commitment to long-term solutions by reallocating resources toward healthcare.
Ghana, for instance, has already begun working on strategies to mitigate the impact of USAID’s withdrawal. In contrast, Liberia remains caught in bureaucratic inertia, leaving its most vulnerable citizens to suffer the consequences.
For Johnson, the uncertainty is agonizing. A father who has raised seven children while living with HIV, he recalls the dark days before widespread access to treatment. “The first time I went public, it was a nightmare. My kids were thrown out of school, and even today, people still call them ‘AIDS children.’”
