A Maryknoll lay missioner warns that young East Africans are forgetting the ravages of AIDS.
By Paul Jeffrey
On a cracked mud wall in her humble home, Laurencia Makanya has hung reminders of what keeps her alive. A picture of Jesus bears a Swahili inscription proclaiming that his blood has saved the world. Beside it hangs an old calendar from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) that for years funded life-saving medication for people living with HIV.
Faith and modern medicine have kept Makanya alive, even thriving, since she learned in 2007 that she was infected with the virus.
“There was a lot of fear and stigma then,” says Makanya, who lives in a small village outside the city of Mwanza on Lake Victoria’s eastern shore. At first, her family insisted she use separate dishes and utensils at meals.
“But a friend took me to Uzima Centre. They helped me eat better, get my strength back, and start meeting with others who were HIV positive. I felt less alone,” she says.
Founded by Maryknoll Sisters during the burgeoning AIDS epidemic in the 1990s, Uzima Centre, since its inception, has addressed needs not being met elsewhere.
“We looked for what was missing from the overall AIDS response. Others were doing testing and counseling and providing ARVs (antiretroviral medications), but there was little to no psychological support for people with the virus, no support groups for them or their families,” says Joanne Miya, a Maryknoll lay missioner who first came to Tanzania in 1984.
“We made a lot of home visits and accompanied people who were dying surrounded by the misinformation and fear associated with the pandemic,” she says.
“When ARVs finally became available, government hospitals took on their distribution. We just continued the accompaniment and support groups, and assistance with other medical care for their secondary infections, which are fewer and fewer these days because everyone is doing quite well on the ARVs.”
When Makanya developed appendicitis, for example, Uzima paid for her surgery, as well as for her children’s school fees, says Miya, who served as director of the center for two decades, beginning in 2006.
“Our primary mission is to provide hope,” she says. “Without hope, nothing we do would make a bit of difference. People have to believe that life can and will get better.”
Because Uzima focuses on supportive services, it was less vulnerable to the massive cuts suddenly imposed on AIDS programs across Africa when the Trump administration slashed funding for PEPFAR and eliminated the U.S. Agency for International Development last year. Agencies offering medication, testing and counseling laid off staff and reduced services, but Uzima — with funding from Maryknoll and private foundations in the United States and Europe — continues to serve people.
Nevertheless, the uncertainty took a toll, and Miya worries that cuts to aid — as well as signs that younger East Africans may be lowering their guard against the disease — may bring devastating consequences.
“Our lives depend on that medicine,” Makanya says. “When the funding was cut, I was scared.” Fortunately, her prescription for government-supplied ARVs was renewed.
Makanya’s husband, however, lost his stipend as a volunteer counselor at another AIDS organization. The couple now lives on the income from a small stand in front of their house where Makanya sells fruits and vegetables. She started the business with help from a savings and loan group at the Uzima Centre. The stand’s sales keep them afloat.
The political situation inside Tanzania hasn’t helped. When post-election violence swept across the country in late 2025, Makanya had just bought a large quantity of bananas to sell. As government sweeps forced people to remain at home, she too stayed inside, and the bananas rotted.
Miya says Makanya’s bananas illustrate the vulnerability of the poor, whatever their HIV status.
“We’ve realized over the years that everyone who comes to us for help doesn’t do so simply because they’re HIV positive. They come because they’re HIV positive and they’re poor. They lack the ability to meet their families’ basic needs,” Miya says.
“Now all our clients are required to be part of a village savings and loan program. Even if they can only save a little, it adds up.”
The face of HIV in Africa is changing, Miya says, noting that a significant number of patients are over 60 years old. As age limits patients’ mobility and their ability to earn an income, Uzima works with their family members.
“If they wake up not feeling so good today, there’s someone else who can sell the fish or soap or peanuts,” Miya says.
Although treating geriatric HIV infections is a large part of the AIDS response in Africa today, Miya worries things may change for the worse.
“The older generation understands the importance of adherence, that staying on their medicines keeps them alive,” she says. “The young generation doesn’t remember the AIDS pandemic. They don’t remember all the adults dying. They don’t remember losing an entire generation.”
As a result, Uzima is stepping up its work among youth.
“This is the next challenge we face, though it means in some ways going back to the beginning when the government used billboards and the radio to educate people. In recent years, too many people have grown lax about HIV. That’s a dangerous thing,” says Miya, who stepped down as Uzima’s director in January. She remains connected to the center, supporting Uzima’s new director, Abdon Daudi.
Miya says Tanzania still faces a variety of cultural challenges in responding to HIV/AIDS, such as ineffective treatment offered by traditional healers. Unsanitary female genital mutilation persists, endangering girls. Then there’s the widespread practice of widows being passed on to their deceased husband’s brothers. And, Miya says, poor women too often accept relationships that guarantee food for them and their children — but come at the cost of HIV infection.
The most dangerous practice, however, may be forgetting the virus’s past ravages.
“What’s scary about the crisis in funding is that if the supply of ARVs is interrupted, and people miss even a few doses, there’s a high risk of developing a drug-resistant strain of the virus,” she says.
That, she says, would be a public health disaster.
“We’d go back to the beginning, when we essentially had a hospice program,” she says. “We want people to find the support they need to live full lives. Our work will continue changing, but at the end of the day, it remains helping people find hope.”
Featured image: Maryknoll Lay Missioner Joanne Miya (left) talks with Laurencia Makanya, who sells vegetables and charcoal from a small stall in front of her home in a village near Mwanza, Tanzania. Makanya, who is HIV positive, participates in a savings group coordinated by Uzima Centre, where Miya served as director from 2006 until January 2026. (Paul Jeffrey/Tanzania)
