Civil society has criticised the government for not being proactive enough in the face of cuts to crucial public health services that were funded by the U.S. Agency for International Development through PEPFAR (the U.S President’s Emergency Plan for AIDS Relief).
“We made noise. We’ve been saying that the U.S funding cuts will affect us a lot. And you know what we got? We were called names,” says Treatment Action Campaign chairperson Sibongile Tshabalala, speaking at the opening of the South Africa AIDS conference in Johannesburg this week. Earlier this year, during a media briefing on the impact of U.S funding cuts, health minister Dr Aaron Motsoaledi accused people who said South Africa’s HIV programme would collapse because of the funding cuts of “propagating wrong information” and adopting “the Afriforim approach”. Afriforum is an Afrikaner lobby group that has been calling for protection from what they call a “genocide”.
“The science now is showing that if we do not do anything now, we are going to lose our lives. We are going to lose our people. All the gains that we have made will go down the drain,” she says.
Research presented at the International AIDS Conference in July shows that HIV testing had decreased by 8.5% from the first quarter of 2024 to the first quarter of 2025. There’s a 31% reduction in HIV diagnoses and a 30% reduction in the number of people starting HIV treatment.
“We also know that the 40 USAID-funded projects were abruptly cancelled, and we saw the withdrawal of about 8,500 PEPFAR-linked staff, which halted mobile clinics, impacted on testing, and impacted on PrEP roll-out as well,” says Professor Glenda Gray, one of the country’s leading HIV researchers.
Walking a tight rope
Head of the United Nations in South Africa, Nelson Muffuh, says it’s important to balance the need for urgency with responsible interventions.
“In the face of life-saving interventions, it is understandable that people at the forefront of the effort to prevent deaths will feel frustrated. But any responsible government has to properly assess the challenges and the impacts, and look responsibly for the resources, over time, but also immediately to plug the gaps,” Muffuh tells Health-e News.
He says there’s an obvious need for urgency to prevent deaths. But the government has shown a commitment to working with its partners both at home and globally. And South Africa continues to lead in the global HIV response.
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“South Africa is already leading on multiple fronts in terms of prevention and having the largest treatment programme in the world – largely through its own national resources,” says Muffuh.
The government funds around 74% of the country’s HIV programmes. In July the government announced that additional funds of over R700m would go towards plugging gaps caused by the lost funding.
Deputy President Paul Mashite, who is also the chairperson of the South African National AIDS Council (SANAC), said the government would protect the gains made in the fight against HIV.
“We are now concentrating on augmenting our domestic funding, initiating national campaigns, and exploring partnerships with BRICS nations and the private sector to address the funding deficits.”
Call for more visible leadership
In addition to having the world’s largest HIV treatment programme, with around 6.3 million people on antiretroviral therapy (ART) in 2024, South Africa also has the largest PrEP, pre-exposure prophylaxis, programme. According to government data, more than 1.9 million have started oral PrEP since 2016.
The government hopes to expand PrEP access to more people soon. The country is among the first that are earmarked to receive doses of a twice-yearly HIV prevention drug called lenacapavir (LEN). The roll-out of this injectable is projected to start around April 2026.
This is a development that, activists say, couldn’t come soon enough. Access to this drug is based on an agreement between The Global Fund and the manufacturer, Gilead Sciences.
“We want to congratulate the South African government for making this effort; however, we are concerned as communities. We know that the Global Fund is supporting South Africa to access LEN for two and a half years. And this will only cover about 480,000 people,” says Tshabala.
“The question is: who will be first in the queue and who will be unfortunate?”
“We are demanding from you, Deputy President, as a leader and the chairperson of SANAC to push. Work with us to develop a sustainable plan to address what will happen to the people of South Africa after these two and a half years.” – Health-e News
