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In the early 2000s, the U.S. started investing millions, eventually becoming billions of dollars, into fighting AIDS around the globe. The effort is credited with saving more than 25 million lives, largely through the distribution of lifesaving drugs. NPR's Jonathan Lambert reports on new research highlighting another benefit of those HIV drugs, drastically fewer orphans.
JONATHAN LAMBERT, BYLINE: In the early days of Uganda's HIV epidemic, Dr. David Serwadda traveled to the Rakai District in the rural south to investigate some of the earliest cases. As the epidemic grew in the late '80s and early '90s, the toll there was severe.
DAVID SERWADDA: You could walk in households, and you just have graves around household. There were households in Rakai that were actually headed by orphans.
LAMBERT: Serwadda recalls visiting what looked like an abandoned household in 1993.
SERWADDA: We just kept shouting, is anybody home? And then a young boy, aged 9, and two children, aged 6 and 7, came out. We asked where - you know, where are the parents? The parents were gone.
LAMBERT: That's likely because they died of AIDS. If you were a kid with an infected mother back then, you were 20 times more likely to be orphaned. Such orphans faced stigma, higher rates of school dropout and mental health issues. Many ended up in poverty.
SERWADDA: Some kids were just left with no parent and with no guardians to take them over. It was heartbreaking.
LAMBERT: Today, the situation has become much, much better. The risk of kids becoming orphans because of HIV has plummeted. That's according to new research published in The Lancet Global Health by Serwadda and his colleagues. The reason? - lifesaving HIV drugs called antiretrovirals, delivered primarily by U.S. foreign aid.
SERWADDA: I'm about 70 years now. In public health, I've never seen a program intervention that just had this huge impact.
LAMBERT: It seems obvious that giving parents with HIV lifesaving drugs would mean fewer orphans. But to understand just how much of a difference they made, the team analyzed data on births, deaths and HIV status among households in Rakai District from 1995 to 2002. They found the number of orphans declined dramatically, from about 21% of kids to just 6%. Rachel Kidman is an epidemiologist at Stony Brook. She wasn't involved in the study.
RACHEL KIDMAN: The findings are just so clear. This decline in orphanhood is absolutely because adults have access to lifesaving antiretroviral drugs.
LAMBERT: Continued access to those drugs is now in question after the Trump administration's drastic cuts to foreign aid. Last year, many in Uganda couldn't get their HIV medicine, which they have to take every day, because the health care workers delivering them lost their funding. Kidman is concerned that could mean more HIV orphans.
KIDMAN: And I think the consequences for children are going to be very dire.
LAMBERT: In a statement, the State Department told NPR that the U.S. continues to provide lifesaving treatment for people with HIV. David Serwadda says it's true partial funding has resumed for many programs.
SERWADDA: But some programs just never started.
LAMBERT: Over the next five years, the U.S. plans to shift responsibility for these programs to Uganda. That transition will be a massive challenge for the country, especially after the damage done to health systems by last year's cuts. But Serwadda thinks their study reveals the stakes - future generations of kids depend on pulling it off. Jonathan Lambert, NPR News. Transcript provided by NPR, Copyright NPR.
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