NAIROBI, Kenya — A year ago, two-year-old Evans arrived at Nyumbani Children’s Home in Nairobi, suffering from both HIV and tuberculosis. With no family available to provide care, he was referred to the orphanage by a health facility after his treatments proved ineffective. The existence of Nyumbani Children’s Home has kept Evans alive, but looming political decisions made far away could threaten his fragile future. Nyumbani offers Evans and around 100 other children crucial antiretroviral medications, accessed through the U.S. Agency for International Development (USAID) via the Kenyan government.
Recently, an executive order issued by U.S. President Donald Trump to freeze funding for USAID raises concerns about the impact on Nyumbani’s supply of life-sustaining antiretroviral drugs, which play a vital role in halting the replication of the HIV virus in individuals. Trump’s directive calls for a 90-day review of nearly all U.S. foreign assistance while efforts are underway to shut down USAID operations. The repercussions are being felt globally, with numerous jobs jeopardized and humanitarian programs disrupted worldwide. For children at Nyumbani, this translates into a dire situation that could be a matter of life or death.
As Evans engages in play with his peers, he remains blissfully unaware of the uncertainty awaiting him, although his caregivers grapple with worry for his wellbeing. The somber sight of tiny graves on one side of the orphanage serves as a harrowing reminder of the potential outcomes of losing access to USAID assistance. Sister Tresa Palakudy, who has devoted 28 years to caring for children at Nyumbani, recalls the tragic experiences before the introduction of USAID support. “When we started caring for them, they didn’t look like they had life in them,” she said. “One after another, they died. It was so painful, and I don’t want to see that happen again.”
Founded in 1992 by Christian missionaries, Nyumbani originally functioned solely as a rescue center for abandoned children living with HIV. The initiative focused primarily on palliative care prior to the introduction of antiretroviral medications. The launch of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003 brought newfound hope to children grappling with HIV across Africa, including the residents of Nyumbani. PEPFAR significantly depended on funding from USAID to provide humanitarian support targeting HIV.
“USAID started delivering ARVs free of charge,” Sister Palakudy explained. “We began administering these medications to all our children, and their lives transformed. They became healthy and could attend school and live like other children.” Over the past twenty years, the U.S. government, via PEPFAR, has allocated upwards of $8 billion for HIV/AIDS treatment for nearly 1.3 million people in Kenya. Nyumbani has benefited greatly from USAID and PEPFAR’s contributions, receiving more than $16 million from 1999 to 2023. This assistance has allowed the institution to reach around 50,000 children through its rescue efforts and outreach initiatives, including Lea Toto and Nyumbani Village.
However, 2023 ushered in a discontinuation of direct funding from USAID, coincide with scrutiny surrounding allegations of misconduct, including sexual abuse claims made against the orphanage by former residents. Although the institution denies any cover-up actions, it claims to have adhered to protocols by reporting allegations to local authorities. Investigations by the Kenyan police have yielded inconclusive results. The funding interruption was reportedly unrelated to the investigations, emerging from a broader policy shift within USAID directing aid through government bodies instead of allocating it directly to organizations.
This policy alteration impacted various organizations dependent on external funding, which now must look to government programs for similar support. Consequently, Nyumbani was forced to reduce its outreach initiatives and refer recipients to government facilities. Despite the setbacks, Nyumbani continues to depend on USAID for the supply of critical PEPFAR HIV medications offered at no cost. “The future is uncertain,” Executive Director Judith Wamboye remarked, noting that the Kenyan government has indicated their ARV stocks may only last an additional six months.
According to amfAR, the Foundation for AIDS Research, approximately 1.3 million individuals in Kenya rely on HIV/AIDS treatment, with around 1,602 orphans and vulnerable children linked to PEPFAR’s resources. The organization cautions that the freeze on foreign assistance from President Trump could greatly risk access to essential health care for these at-risk populations. Children like Mercy, who has been a resident at Nyumbani for over a decade, exemplify these worries. Having previously endured severe health issues due to a weakened immune system, Mercy credits ARV therapy with saving her life, but the funding freeze has left her frightened about the reemergence of previous ailments.
“I am very afraid that previous illnesses I experienced when I was young will reoccur. And now that I have finished high school and am ready to join college, I am scared it will ruin everything,” she shared. The orphanage estimates that annual costs for HIV treatment per child amount to $1,139, which includes not only antiretrovirals but also other necessary medications to address common opportunistic infections. Wamboye cautioned that should PEPFAR cease its operations permanently, the escalating costs for ARVs could lead to situations where children living with HIV may succumb to their conditions. “This is a life-saving situation and we cannot sit and wait and bargain on human life,” she emphasized, advocating for urgent action to safeguard the lives of vulnerable children.
