The head of the family is 17. Money is tight. The roof leaks. How did this happen?

Alumbwe, who's 12 and lives in Zambia, gets ready for school. It's a 2 mile walk from his home. He and his brothers have lived without adult supervision since their parents died of AIDS earlier this year. Andy Higgins for NPR hide caption

Whenever it rains, Joseph, Gift and Alumbwe — ages 17, 15 and 12 — scramble to move their clothes to a dry corner of their home, deep in the Copperbelt Province of Zambia. That's because rain streams through holes in the roof.

"The house is not okay. Even though we live here it's only because we have nowhere else to go," says Joseph, speaking in the local language Bemba. "When it starts raining, where we sleep becomes wet."

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They don't have to move their mattresses, he explains, because they don't have any — the boys sold them when they needed money. Instead, they sleep on a bamboo mat on the floor and share a blanket.

Their mother died in January, their father in February. Now these brothers are in the process of figuring out the basics of living alone.

NPR is not using the brothers' last name because they are minors.

Both parents were HIV positive but had been able to survive because of the daily medications they took to prevent the virus from progressing. When the U.S. overhauled foreign aid at the start of President Trump's second term, there were major cuts to global health — and disruptions to the U.S.'s flagship efforts to combat HIV/AIDS globally called PEPFAR or the U.S. President's Emergency Plan for AIDS Relief.

The boys say that, in the overhaul, their parents could no longer get their HIV medications as the program that delivered medication to their remote area suddenly stopped. It took just about a year for both parents to succumb to the virus.

The phenomenon of child-headed households and orphans was a defining element of the early years of the AIDS epidemic in the 1980s and '90s. But it diminished with major support efforts from the U.S. as well as the widespread availability of HIV medications that dramatically improved life expectancy.

It's too early for official statistics to capture whether the shifting aid landscape has caused a spike in orphans and child-headed households. However, a reverend in Zambia — Billiance Chondwe — says he's noticed a change.

Two of the brothers prepare a meal outside the small home where they now live. They say they often can only afford one meal a day — boiled sweet potatoes. Andy Higgins for NPR hide caption

NPR profiled Chondwe — affectionately known by his congregation as Pastor Billy — last year as his community dealt with the aid cuts and disruptions. At the time, he told NPR many of his community members had suddenly lost access to their HIV medication as the nearby PEPFAR-funded clinics they depended on had shuttered. Now, he reports, children are paying the price. In his community, he says, parents are dying of HIV. And that's leading to the return of child-headed households.

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He is trying to help 25 newly orphaned children, up from 11 a couple months ago. "There is a lot of stress and pressure," Pastor Billy says, ticking off a long list of concerns. "They don't have enough food. Where they are staying [is not suitable]. There's no support."

Brothers Joseph, Alumbwe and Gift pray before sharing a meal. Andy Higgins for NPR hide caption

"God can take care of us"

As a teenager, Pastor Billy lost his twin sister to AIDS. "It brought me to my knees," he remembers. In the decades since then it's driven him to help others with the virus. Lately, that work has entailed tracking down people whose U.S. funded HIV-clinics closed overnight as a result of aid cuts last year.

Sometimes, he can help people connect with Zambian government clinics to get the medications they need — but not always. Increasingly, he says, he's finding children scrambling to figure out what to do as their parents get sick without their HIV/AIDS medications. That's what happened in January when a community member asked him to check on a family living in a remote area. When he got there, he found Joseph and his brothers along with their ailing father.

"There was so much fear in the faces of the boys. There was so much worry and panicking in the face of the father," Pastor Billy recalls.

Because Joseph's family lived three, almost four, hours walking distance from the nearest hospital, community health workers — paid for by a U.S. government aid program — had brought HIV medications to their home. U.S. funding cuts changed that.

"In the rural remote areas, there used to be mobile clinics and nowadays it is not there," says Pastor Billy.

The boys watched as AIDS took hold and their parents grew weak and lost their appetite. Soon they were losing weight rapidly and struggling with diarrhea. They didn't have the strength to walk to the hospital. So the family came up with a plan of action.

"We started selling things in the house," Joseph says. "Whoever wanted to buy a mattress, we would sell. Whoever wanted pots, we would sell."

The money was to pay for a motorcycle taxi to get to the hospital.

Each night the boys would kneel in the dark and pray for help. The final months were fraught and painful as their parents argued about how the virus had been introduced into their household and worried about what would happen as their condition worsened. Their mother ended up going back to her sisters' place and dying there. Once their father died, Joseph says, he had no idea what to do.

"We started going to church so that God can take care of us," he says.

"Creating orphans at a remarkably rapid rate"

When the HIV/AIDS epidemic first hit Africa, the virus was infamous for killing people in their child-bearing years — and "creating orphans at a remarkably rapid rate," says Dr. Eric Goosby, the second director of PEPFAR from 2009 to 2014 and now a professor of medicine at University of California, San Francisco. That's what he told NPR last year. "The community around [the kids] rejected them because the stigma for HIV was so severe."

PEPFAR, which was created under President George W. Bush and grew to be a widely celebrated program, was committed to helping these children.

"We created a system of care that took care of almost 6 million kids every year," Goosby explains. "It's a largely unsung story for PEPFAR and it's the only non-traditional medical intervention PEPFAR heavily funded."

The system found local adults and provided stipends so they could care for the children and keep them in their home community. PEPFAR also paid for education, nutrition and medical care since about a quarter of the orphans and vulnerable children were HIV positive.

Pastor Billy says he saw how these efforts transformed children's lives and futures . Now, much of that support network has disappeared. "Cutting [aid] this suddenly has taken us backwards to a place and a season of hopelessness. There is no clear direction, especially on how we can help child-headed homes," he says.

Asked to comment on these assertions and the situation Joseph and his brothers find themselves in, the State Department sent NPR a statement saying that the U.S. is the most generous country with humanitarian assistance. "If there are such tragic cases happening around the world, it's not because we're not spending enough money. It's because the rest of the world is not spending enough money," the statement said.

The statement also said: "The United States has not cut health funding, including PEPFAR, for Zambia."

While appropriations from Congress for HIV have not changed, the money is often not being spent. The Trump Administration is in the process of revamping how the U.S. does global health work and it is trying to hammer out new agreements with individual countries, including Zambia. The Foundation for AIDS Research or amfAR found an almost 20% drop in PEPFAR expenditures between 2024 and 2025 in Zambia and the loss of more than 5,000 PEPFAR staff in the country. In the Copperbelt Province in particular, the amfAR country report shows that thousands of HIV-positive people lost access to their HIV medications between 2024 and 2025.

" The children they left behind"

As his family life turned upside down, Joseph says he had no choice but to drop out of school and give up on his dream of becoming a doctor. Unable to pay rent, the boys moved several hours away to the small, dilapidated house with the leaky roof where rent is minimal.

"Sometimes the roofing sheets will start coming off because of the wind," Joseph says.

Joseph got a job as a part-time security guard so he could provide a home for himself and his brothers — and so they can continue their schooling. As he puts on his uniform for work, his brothers head to school. Gift wants to be an engineer and Alumbwe a soldier. While school is free in Zambia, the boys struggle to pay for school books. But they still attend class.

Joseph dropped out of school and got a job as a part-time security guard. He also works odd jobs. The money he earns enables him to rent a house for himself and his brothers and take care of other expenses. Andy Higgins for NPR hide caption

Gift and Alumbwe walk to school. Gift hopes to become an engineer; Alumbwe wants to be a soldier. Andy Higgins for NPR hide caption

When Joseph is not at work, he says, he's either doing odd jobs to make additional money or trying to get medication for his two brothers, who are both HIV positive. Their clinic is still an hours-long walk away with a multi-hour wait once there.

Waiting in those lines, Joseph says, he's realized how common his situation is. He says he sees many other children in similar circumstances. Sometimes Joseph doesn't make it to the clinic before they run out of the drugs his brothers need, so they must go a day or so without their pills. Pastor Billy tries to help with the medication pick-up but he too lives far away.

About once a month their Uncle John travels from several hours away to check on the boys.

The boys pose for a picture with Pastor Billy (left) and their Uncle John (right) outside their home. Andy Higgins for NPR hide caption

"It brings me sadness and heartache to see the children [my brother] left behind," he says in Bemba. He says he feels guilty that he can't house the boys but his household has not only his own five children but also his late sister's six children.

Right now, he says, the best he can do is bring food when he visits. "I do some farming and when I harvest those crops I will then share with them," he says.

"If my parents were still alive"