The Networking HIV and AIDS Community of Southern Africa which relied on USAID money to fund one of their projects. (Supplied: NACOSA/Anotherlove Productions)News & Features
3rd March 2025 | Jesse Copelyn
South Africa’s public health system is in turmoil after the widespread cancellation of USAID funding agreements. Among others, a USAID-funded project that helped to keep orphaned children on their HIV medication was forced to close. HIV testing services are also severely impacted in some areas.
Critical USAID-funded health projects in South Africa have been forced to shut down, including some HIV testing and prevention services. This follows the mass termination of USAID contracts globally from 26 February.
One of the affected projects was run by the health non-profit Networking HIV and AIDS Community of Southern Africa (NACOSA). It relied on USAID money to support tens of thousands of vulnerable and orphaned children living in the Western Cape. All staff involved in this project have been let go after USAID cut the programme’s funding effective immediately.
NACOSA‘s communications head, Sophie Hobbs, told Spotlight and GroundUp that the project “identified children and adolescents living with HIV” who were either orphaned or living in “extremely precarious situations”.
“Many are being cared for by relatives who are unemployed… Often they are not attending school, and the households are food insecure. [In many cases] there are very high levels of abuse and neglect”, Hobbs added.
The project would help these children to start antiretroviral therapy and to stay on their medication – for instance, by reaching out in cases where they had missed appointments. Studies from across Africa have found that children living with HIV are often less likely to stay on their antiretroviral medicines (ARVs) if they are orphaned. It’s for this reason that NACOSA targeted this group.
The project would also identify and refer orphaned children for testing in cases where they didn’t know their status (since orphaned children are more likely to have HIV, it makes sense to focus on them). Staff also linked vulnerable young people to psychosocial counsellors, flagged cases of abuse, helped enrol caregivers in parenting programmes and assisted families with accessing food parcels and social grants.
26 000 vulnerable children without services – and counting
In late-January, all of these services were immediately halted following an executive order by US President Donald Trump, which paused all foreign development funding for 90 days, pending a review.
The US State Department later released a waiver, which supposedly allowed life-saving services to continue, but this had little impact in South Africa. While USAID asked certain organisations to provide revised budgets that only covered essential services, it never approved them. Funding remained frozen.
NACOSA estimated that over 90 days, 26 000 orphans and vulnerable children living in the Western Cape would not receive services. Of these, roughly 7 000 were living with HIV “and could be at risk of treatment default”.
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Now, those numbers will grow indefinitely. The 90-day review period, which simply paused funding, has been swept aside and the flow of money has been stopped for good. On 26 and 27 February, USAID recipients were notified that their “award is being terminated for convenience and the interests of the U.S. Government,” and that “continuing this program is not in the national interest”. Overall, the Trump administration says it is cancelling over 90% of all USAID contracts globally.
Without the NACOSA programme, vulnerable children in the Western Cape will still be able to continue fetching their ARVs from public health facilities. But there are no longer teams of caseworkers to help get them back on treatment if they miss appointments, or to connect them and their families to other services. In addition, some staff will no longer be available to refer children for testing. As a result, health workers may miss new HIV cases or fail to get to them as quickly – a problem which extends far beyond this programme.
“In central Johannesburg, HIV testing has almost completely stopped”
Professor Francois Venter, the director of the Ezintsha research institute at Wits University, said that USAID funded many of the counsellors who were conducting HIV testing in South Africa’s public sector. “These people are either moving through the clinics or have tents at the clinics [where they conduct HIV tests],” he explained. “They’re often deployed in family planning clinics, antenatal sites or in general queues. [And] they’re out in the community, for instance at taxi ranks, offering people testing”.
Now that these USAID-linked counsellors are gone, the rates at which people are being tested has plummeted in certain areas. “In central Johannesburg, HIV testing has almost completely stopped,” Venter said. “In high-impact districts, the HIV testing programs are almost entirely reliant on [USAID-linked] people, so testing [in those areas] has just stopped.”
JUST PUBLISHED | The SA Medical Research Council relies on US agencies for 28% of its budget, leaving it “heavily exposed” to the US health research funding cuts. Professor @ntobekon gives us more details in this report by @catherinetom. @MRCza https://t.co/kHlgIz14jp
— Spotlight (@SpotlightNSP) February 11, 2025
Similar observations were shared by clinicians at Helen Joseph Hospital, in Johannesburg, who reported: “We used to routinely test and start treatment for inpatients with HIV symptoms. Now, with no counsellors at Helen Joseph, almost no one is being tested unless a doctor orders an [antibody test]”.
Dr Kate Rees, a public health specialist at the Anova Health Institute – a non-profit that received USAID funding – explained that the HIV counsellors that were employed via USAID were also involved in following up with patients. “If they [HIV counsellors] see that they’ve [patients] missed their appointment, they’ll give them a call and ask them to come back in. [Without them] we’ll see increased missed appointments”, said Rees adding that the result would be more interruptions in ARV treatment.
Victims of sexual violence left stranded
In addition to its project with vulnerable children, NACOSA also ran a USAID-funded programme – which is now gone – that helped young women across seven provinces. This programme, said Dr Ntlotleng Mabena, a technical specialist at NACOSA, had two parts.
The first was an HIV prevention service that linked young women to HIV testing, contraceptives and HIV prevention medication. The second component helped people harmed by gender-based violence to access a minimum package of care that includes treatment of their injuries, HIV testing and provision of a medication taken to counteract a possible exposure to HIV. Staff would also link victims to other forms of assistance, including psychosocial counselling, legal help and forensic services.
While people who have been raped can still get medical and legal services, this will become more difficult as the programme helped them to navigate the system quickly and compassionately. “Now they have to go through the process of waiting in long queues, and disclosing to multiple people what happened to them to eventually get the services they need,” said Mabena. In addition, she said they won’t get the same level of psychosocial support or follow-up care.
According to Hobbs, during the 90-day suspension, 10 000 individuals affected by sexual violence would lose access to the programme’s services. Over 4 000 would have been children. These numbers will inevitably rise now that the project has ended.
Published by Spotlight and GroundUp.
