It’s been six months since the U.S froze and subsequently cancelled critical funding of HIV programmes around the world. Despite South Africa being a major beneficiary of U.S HIV funding through PEPFAR (the U.S President’s Emergency Plan for AIDS Relief), health minister Dr Aaron Motsoaledi has previously stated that the country’s HIV programme would not be derailed by the funding cuts.
But recent research suggests there’s cause for concern.
“Funding cuts have hindered the progress related to the HIV epidemic,” says Khensani Chauke from the Gauteng Department of Health.
Chauke was among researchers presenting their findings on the impact of U.S funding cuts on the HIV response at a press conference hosted by the International AIDS Society this week.
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“Johannesburg was the recipient of the Accelerating Program Achievements to Control the HIV Epidemic (APACE) award that was funded through PEPFAR to support the achievement of 95, 95, 95,” says Chauke.
The 95-95-95 targets are part of a larger UNAIDS goal to end HIV as a public health threat by the year 2030. The targets are that by 2025: 95% of people with HIV should know their status; 95% of those who know their HIV positive status should be on treatment, and that 95% of those on treatment should have an undetectable viral load.
Impact on HIV services
“The [APACE] award was withdrawn in February 2025. This impacted key healthcare workers, including the counsellors who were providing community-based HIV testing to vulnerable populations,” says Chauke.
“The study team assessed the impact of the award termination by comparing the HIV testing, HIV diagnosis and ART [antiretroviral therapy] initiations from the years 2023, 2024, and 2025.”
Chauke and her co-researchers found that HIV testing dropped by 8.5% in the first quarter of 2025 when compared to the first quarter of 2024.
“There was also a 31% decline in HIV diagnoses and a 30% decline in antiretroviral initiations. HIV positivity declined from 3% to 2.2%.”
PEPFAR funding made up around 17% of the country’s HIV programme. Much of this funding went towards staff in 27 high HIV burden districts. Since the funding withdrawal, more than 8,000 people have lost their jobs. According to Chauke, the impact on Johannesburg’s health facilities has been huge.
“In facilities where PEPFAR-funded staff were allocated, there was a huge reduction in ensuring that clients get tested and they are put on treatment,” she says.
The management of the patients who are on ARVs has also taken a knock in the absence of PEPFAR-funded staff who only dealt with HIV management.
“And we have seen a huge drop in the viral load suppression, especially in the paediatric group, where these children are caregiver-dependent. We were working on a family care model that focused on caregiver and child pairings to assist with disclosure and treatment adherence, which has since been affected,” says Chuake.
Call for transparency
Activist and founder of the Treatment Action Campaign, Zackie Achmat, criticised the South African government’s lack of transparency in releasing the data on the scale of the impact of the PEPFAR funding cuts.
“The call is for governments to make the data accessible to activists because we need to know where to go and how to reduce the impact. And how the programmes are going to be dealt with. Our government has been neglectful in this regard.” – Health-e News
