US President Donald Trump’s administration has cut life-saving aid to many African countries. (Photo: White House/Shealah Craighead)Comment & Analysis
8th December 2025 | Marcus Low
The year’s biggest health story by far has been the cuts to US aid for health and US support for health research. But it’s also been a year of important HIV prevention developments, NHI court cases, ongoing crises in some of our provincial health departments, and some first steps toward accountability for the corruption at Tembisa Hospital.
In January, newly inaugurated United States President Donald Trump signed an executive order pausing all foreign aid for 90 days. Soon after, money started drying up for US-supported health services across Africa. By the end of the year, the United States President’s Emergency Plan for AIDS Relief (PEPFAR), formerly the jewel of the US’ armoury of soft power, had been reduced to tatters.
In South Africa, the funding cuts were devastating for many service delivery NGOs and disproportionately impacted services for vulnerable groups, such as men who have sex with men and injecting drug users. Having largely underplayed the crisis and dragged its feet, government eventually announced some extra funding in response to the cuts, although this only made up for a fraction of what was lost.
Figures obtained by Spotlight and GroundUp News using a Protection of Access to Information request, showed that the number of viral load tests conducted in 2025 were slightly lower than in 2023. Since the HIV programme should be growing by a few hundred thousand per year, these numbers indicate that something has indeed gone quite wrong in our HIV programme. That said, since South Africa funds most of its HIV response itself, the impact of the aid cuts here was much less pronounced than in other countries in the region, such as Mozambique, where the dependence on US aid was much greater.
This year also saw massive cuts to US funding for HIV and TB research. This was not aid, but money distributed through competitive grant-making processes. Since we have some of the world’s best HIV and TB researchers and research organisations in South Africa, these cuts hit us particularly hard. Here too, there was eventually a partial bailout from government and two philanthropies.
Despite these setbacks, some important studies are proceeding. A massive clinical trial of a new TB vaccine, partly conducted in South Africa, completed recruitment ahead of time in April. Researchers also announced a large study into asymptomatic TB that is set to start early in 2026.
HIV prevention progress
Last year’s biggest HIV news was that the six-monthly lenacapavir injection is highly effective at preventing HIV infection. This year, that injection was registered by the South African Health Products Regulatory Authority and the Department of Health announced plans to start providing it at around 10% of clinics from April 2026. Deals were announced that will ensure an affordable supply of generic versions of the jab from 2027. Early signs are that a newer formulation of the drug might provide 12 months of protection per shot.
In some more good HIV news, a major court ruling in October cleared the way for specially trained pharmacists to provide people with antiretrovirals without a script from a doctor and it emerged that most children with HIV in the country have in the last two years been switched over to a new, more effective, and more palatable form of antiretroviral treatment.
Yet, with around eight million people living with the virus, HIV is set to remain a major health issue in South Africa for years to come. As with TB, new infections and deaths are declining, but slowly.
On the other hand, non-communicable diseases like diabetes and hypertension appear to be trending upward. We’ve seen some compelling research on how to better respond to hypertension, but since our health system isn’t coping with the current levels of diabetes and hypertension, future prospects in these areas are bleak.
A better budget
Meanwhile, what hopes there was in some quarters back in January that government might be willing to compromise on some aspects of their NHI plans were soon dashed by Health Minister Dr Aaron Motsoaledi, who remains staunchly behind the version of NHI set out in the Act signed into law by President Cyril Ramaphosa last year. At our count, eight different court cases have been filed challenging the Act, or parts of the Act. As we unpacked in a special series here and here, we now have a good idea of the issues these court cases are likely to turn on.
There were some good news in May, when after several delays, South Africa’s finance minister presented a budget that included increased funding for health. The overall picture however remains grim, with provincial health departments, even the better functioning ones, still short of the funds needed to employ all the healthcare workers they need.
Much media focus this year was again on the ongoing mismanagement of the Gauteng Department of Health. It culminated with the precautionary suspension of head of department Lesiba Arnold Malotana in October, following a lifestyle audit conducted by the Special Investigating Unit (SIU). Malotana unsuccessfully challenged his suspension in the Labour Court.
His suspension came in the wake of a shocking set of findings from the SIU relating to industrial scale corruption at Tembisa Hospital that rightly dominated the headlines and airwaves for a few weeks. The Gauteng Health Department was also on the wrong side of two high-profile court rulings relating to the province’s ongoing oncology crisis. Also mainly in Gauteng, members of Operation Dudula unlawfully prevented people they deemed to be foreign nationals from accessing several healthcare facilities – in November the South Gauteng High Court ordered them to stop.
Finally, in a glimmer of hope for accountability, in May the Special Tribunal ordered that companies owned by Thapelo Buthelezi should pay back over half-a-billion Rand to the state. The alleged irregularities with emergency medical services contracts secured by Buthelezi’s companies in the Free State and North West were first exposed in an investigative series published by Spotlight in 2018. The wheels of justice may turn slowly, and may not turn nearly as much as they should, but at least they aren’t entirely stuck in place.
