Community health worker Geoffrey Chanda used to distribute HIV medications to long-haul truck drivers and sex workers at truck stops like this one near the border of Zambia and the Democratic Republic of Congo.
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On a morning in early April, Geoffrey Chanda’s phone was going off almost constantly. Truck drivers were calling him.
“They are crying: ‘We’ve got no [HIV] medicine. Where do you get [it] from?’ ” says Chanda, 54.
For 15 years, Chanda has been meeting truckers in dusty parking lots at the border of Zambia and the Democratic Republic of Congo to give them their HIV medications. Now, he says, he doesn’t know what to tell them.
He’s lost his job as a community health worker. The U.S.-funded program he worked for — which supported the mobile clinic where he collected the medications for distribution — shut down.
On inauguration night — 100 days ago this week — the U.S. froze the vast majority of foreign aid, including billions of dollars in programs addressing global health issues. Since then most of the freezes have turned to terminations.
At first glance, it would seem as if Chanda’s job should have been spared.
“We are continuing essential lifesaving programs,” Secretary of State Marco Rubio said in a statement issued on March 28. “We are reorienting our foreign assistance programs to align directly with what is best for the United States and our citizens.”
The continuation of lifesaving programs, the Trump Administration says, include the distribution of HIV medications.
However, on the ground in Zambia, a different reality is apparent. Many HIV-clinics have shut their doors.
A State Department spokesperson said in a statement to NPR this month that U.S. partners who are providing lifesaving HIV treatment have been “notified and urged to resume approved service delivery.” The spokesperson did not respond to requests for information about specific actions the U.S. has taken to resume HIV services in Zambia and elsewhere.
As of this week, Chanda says he’s heard nothing about restarting his work delivering HIV medications, although a limited number of other U.S.-funded HIV clinics in Zambia have restarted with significantly reduced capacity.
Still, Chanda spends his days picking up a string of calls from truck drivers and sex workers who haven’t been able to collect their HIV medications since the end of January — and are now getting sick.
Tracking the truckers
Chanda started this work 15 years ago as a volunteer but, after his own brother died of AIDS in 2018, he decided to do it full time. ” ‘Let me teach others not to get [HIV],’ ” he remembers thinking to himself.
Leaving his job as a miner underground, Chanda moved above ground, spending his days in those dusty parking lots where 18-wheelers line up, many loaded down with freshly-mined minerals. While the drivers were waiting for clearance from government authorities to cross the border, Chanda would make sure those who needed HIV drugs had them before hitting the road again.
He was responsible for coordinating with over 200 truck drivers — as well as more than 150 sex workers. Calling and texting them, he’d figure out when they’d be passing through the border crossing and go meet them armed with their pills and all the information they needed about how not to spread HIV. He’d also helped identify people who were HIV-negative but at high-risk of getting HIV, to help them get information as well as medication that prevents people from getting the virus in the first place.
Long-haul truckers sometimes pause for days at this truck stop near the Zambian town of Chililabombwe as they await approval to cross the border into the Democratic Republic of Congo. Distributing HIV medicine on trucking routes is critical to stopping the spread of HIV, say public health experts.
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Reaching those at high risk
Chanda was part of a broader effort in Zambia and elsewhere to zero in on this population of long-haul truck drivers and sex workers because they’re seen as critical in halting the spread of HIV.
In the early days of the epidemic in sub-Saharan Africa, the virus fanned out along trucking routes as long-haul drivers frequented sex workers. At the peak of the HIV/AIDS crisis in the 1990s and early 2000s, these communities were very hard hit — for example, one study from 2001 found that in South Africa 56% of truck drivers surveyed were HIV-positive. Still today, worldwide, long-haul truck drivers are nearly six times as likely as the general adult population to be HIV-positive, according to a study published last year in BMJ Open.
Zambia sits at a key crossroads on the HIV/AIDS map. The landlocked country in southern Africa is bordered by eight other countries and major transport corridors crisscross the nation. Zambia is heavily dependent on its long-haul truck drivers, in part to export all the copper mined in the country.
So public health experts in Zambia have designed special initiatives to reach this high-risk population. People like Chanda were a key part of the strategy, often working long days under the hot sun to make sure that highly mobile truck drivers — and the highly stigmatized sex workers that they patronize — have access to consistent HIV care and prevention services.
Now, Chanda says he’s alarmed to learn that many of his former clients are getting sick.
On that day in early April, Chanda estimated that about 20 of the 200 truck drivers he worked with have called and told him they’re falling ill without their HIV medications. In the arcades and bars that line the main street of Chililabombwe, near the border between Zambia and Congo, Chanda has heard that one of his drivers passed away in Congo because he didn’t have his HIV medicine.
“He died in Congo. [And] bringing the body [back to Zambia], it’s very expensive,” says long-haul truck driver Roi Silunyange, 54, who knew the deceased man.
Zambian trucker Roi Silunyange, 54, stands in a parking lot at a truck stop near the border with the Democratic Republic of Congo. He says that he knows a fellow truck driver who died while in Congo because he ran out of HIV medication.
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Mwape Shamboko, another driver, standing nearby in the lot that April morning, used to rely on health workers like Chanda and the U.S.-funded system to get his HIV medications. He says there was even an emergency number any driver or sex worker could call if something were amiss. Community health workers like Chanda would pick up.
“If you’re not feeling well, or you need a supply — maybe your medicines have run out — [we] would call that number, and [the community health workers] were always very quick at coming to us and responding to our needs,” Mwape says. “So it was a very, very good system. We were not missing our medications.”
Truck driver Mwape Shamboko, 42, used to depend on health workers like Geoffrey Chanda to get his HIV medications.
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Now, he says, the calls go unanswered. Or if someone does pick up – as Chanda still does – they are unable to help.
No more preventive HIV care
Like the truck drivers, sex workers are also feeling a sense of abandonment. They too report major disruptions in getting their HIV medications – as well as the end of most HIV prevention efforts.
They say this is a major problem because their line of work is so risky. Many of the towns that fly past on the roadside have little work available for the residents, pushing young women into prostitution as one of the only ways to make a living.
Mercy Lungu is a 27-year-old sex worker from Kitwe, Zambia. She is HIV negative but worries that because the local U.S.-funded clinics have shut down, she won’t be able to get access to PrEP — a medication that prevents a person from contracting HIV.
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Mercy Lungu, 27, is one of those women. She’s a sex worker in Kitwe, Zambia. And, while she’s HIV-negative, she knows the HIV is common in her world: One study in the African Journal of AIDS Research from 2021 includes estimates that, in Zambia, between 46% and 73% of female sex workers are HIV-positive, compared to roughly 11% of the general population.
She says she would “love” to have access to PrEP — a medication that prevents a person from contracting HIV. But, she says, the local U.S-funded clinics where her fellow sex workers used to get PrEP have shut down. “When we go there, you find that the staff – they are not there,” she says.
Even if those clinics were to reopen — as the State Department has said that it’s urging — there’s another issue. The pills that prevent HIV may not be available. While the Trump Administration says lifesaving aid, like HIV medication, is allowed to continue, preventive HIV care has not been included in their definition of “lifesaving” — with the exception of prevention of mother-to-child HIV transmission.
Juliet Banda (left) and Mercy Lungu (right) say that the closure of U.S.-funded HIV clinics has sent fear through the sex worker community. “If I am to contract HIV today, and then I don’t have access to medication, then it’s scary,” Banda says. “Even for my colleagues who are [HIV positive and] in this business, we’re really worried.”
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This doesn’t make sense to Juliet Banda, a 26-year-old sex worker also in Kitwe. “We do a lot of movement and a lot of interactions — we sleep with multiple partners — so I think when we think about people like us, [we] need the PrEP,” she says. “Because that’s what will help us to safeguard our lives.”
She says the closure of U.S.-funded HIV clinics has sent fear through the sex worker community. “If I am to contract HIV today, and then I don’t have access to medication, then it’s scary,” she says. “Even for my colleagues who are [HIV positive and] in this business, we’re really worried.”
Geoffrey Chanda says this sense of worry weighs heavily on him too.
He says each time his phone rings he worries it’s another former client who’s without HIV pills and now ill.
And on top of that, he says, now he worries for himself too — and his six children. Without his job, he’s struggling to pay for food for his family. “[We are] still starving with hunger,” he texted this week.
