JUANA SUMMERS, HOST:
And I'm Juana Summers in Zimpeto, Mozambique. We've just arrived at a health clinic on the outskirts of the capital city.
NURJA MAJID: I am Nurja.
SUMMERS: Hi. I'm Juana. Nice to meet you.
We're here to meet a doctor who vividly remembers a time when people here lacked access to life saving HIV/AIDS treatments, even as those same medications were turning the tide on the epidemic in the U.S.
MAJID: We had lots of HIV patients - no treatment at all.
SUMMERS: This is Dr. Nurja Majid. She now heads up the Zimpeto Dream Clinic. She remembers people in those days were so fearful of the disease, they were transporting sick relatives to the clinic in wheelbarrows.
MAJID: I was working with 60 beds, and 80% of my patients were HIV-positive without any treatment.
SUMMERS: Initially, Majid wanted to be a pediatrician, but after seeing the devastating effects of HIV/AIDS, she says, she found her calling.
MAJID: I said no. I got my, you know, reason of life.
SUMMERS: While U.S. funding and influence has had a large impact on fighting the HIV epidemic in Africa, this is a place where Italy's influence has had a role. This clinic is 1 of 7 in Mozambique run by the Community of Sant'Egidio. It's an international Catholic organization founded and headquartered in Rome. There's a photo of Pope Francis hanging on the wall. He visited here in 2019.
MAJID: Yeah. When he came here, he came to visit the patients. It was so, so, so heart-touching.
SUMMERS: When he spoke here, he compared healthcare workers to Jesus, saying they deal with the problem in its entirety, restoring dignity to women and children. Dr. Majid says this organization has a storied history in Mozambique.
MAJID: The Community of Sant'Egidio is very well known because of the peace.
SUMMERS: That is the peace that Mozambique found in 1992, when a bloody civil war was finally over. The peace deal itself was signed at the organization's headquarters. But the war had devastated health infrastructure. And almost immediately, the country was fighting a new battle - the AIDS crisis.
MAJID: There was a lot of stigma, and the people were even not touching the patients, not even feeding them or giving any attention.
SUMMERS: Just not touching them because...
MAJID: No.
SUMMERS: ...They were fearful...
MAJID: No, no. Yeah.
SUMMERS: ...Of contracting...
MAJID: Yeah, yeah.
SUMMERS: ...The virus themselves?
MAJID: Yes, yes. It was the beginning. It was the very beginning.
SUMMERS: At one point, Mozambique's health ministry estimated that national life expectancy had fallen to just 38 years. People were dying and children were being orphaned.
MAJID: So when I saw these orphaned patients, orphaned babies - small babies - with the grandmothers, you know, coming to you, the grandmothers don't know how to give the medication.
SUMMERS: Things started to change in Mozambique in the early 2000s. President George W. Bush launched the President's Emergency Plan For AIDS Relief in 2003. PEPFAR launched after Bush made a moral case for ending the AIDS epidemic. Life-saving antiretroviral drugs became more widely available thanks to PEPFAR and other international partners. Today, the life expectancy in Mozambique has risen to 61 years.
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SUMMERS: Upstairs, a microbiology lab analyzes patient samples to share with other health centers across the country.
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SUMMERS: Program coordinator Flavio Ismael says this location now serves about 6,000 patients of chronic illness. But he points out the system relies on unstable infrastructure, like water and power.
FLAVIO ISMAEL: Water and power are still struggling in country. It's still a huge problem.
SUMMERS: Even in Zimpeto, close to the biggest city in Mozambique, blackouts remain a regular occurrence. And on the day we arrive, massive gas shortages brought on by the U.S. war with Iran are making it harder for patients to get to the hospital and for doctors to visit them.
ISMAEL: Last week, we had three vehicles on Friday doing the queue - whole entire day, without doing anything else. Just trying to have petrol.
SUMMERS: Just waiting in line to get fuel?
ISMAEL: Waiting in line, yes.
SUMMERS: And of course, there is the issue of funding. Last year, the U.S. paused nearly all foreign aid soon after President Trump took office. The Center for Global Development analyzed PEPFAR data and found that more than 100,000 people in Mozambique lost access to HIV medication before the pause was partially lifted.
MAJID: If we don't have these medication, we don't have the reagents, how we can follow the diseases?
SUMMERS: Even though the Community of Sant'Egidio doesn't receive money from the United States government, Dr. Nurja Majid says that her work requires extensive coordination with partners who have lost funding. Her patients came to her in a panic.
MAJID: So we receive even a phone calls of our patients - please just keep for us one year medication. You know, these kind of things. People was just...
SUMMERS: Patients were calling you because they were hearing about this?
MAJID: Yeah, yeah, yeah. So please just keep medication for me. Store some medication for me. I'm coming to take.
SUMMERS: The U.S. is currently reconfiguring its global health aid distribution and has signed a direct agreement with Mozambique's government to provide financial support over five years. Mozambique's health system relies heavily on foreign aid. More than half of its health budget comes from other countries. If international support falls short again, she fears a future that could look more like the past.
MAJID: My fear is going back on that part because you had a hope. You had medication. You know how it is. You saw the paradise, you know? And now you are telling me go back. So yeah, it's very hard.
SUMMERS: A paradise built across decades but still fragile today. This story was supported by the Pulitzer Center.
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