South Africans living with HIV are facing increasing challenges in accessing medication due to the recent suspension of funding from the United States. The funding cuts, primarily affecting the President’s Emergency Plan for AIDS Relief (Pepfar) and USAID-supported programmes, have led to disruptions in healthcare services, forcing patients to ration their medication.
While the South African government covers 87% of HIV/Aids funding, the remainder comes from Pepfar, which directly supports 150 non-governmental organisations (NGOs). These organisations provide vital healthcare services, including HIV testing, pre-exposure prophylaxis (PrEP), and patient support programmes.
Health Minister Aaron Motsoaledi revealed in Parliament that Pepfar funding also covered the salaries of 15,100 health and support workers. At the same time, the government employs around 250,000 professionals within the country’s HIV/Aids programmes.
Despite the cuts, Motsoaledi made it clear that the US is not financially responsible for South Africa’s healthcare crisis: He said: “I want to categorically state that (President Donald) Trump does not owe South Africa a cent. He made his decision, and that’s it. The onus is now on us to decide what to do.”
Experts call for self-reliance in HIV funding
Professor Salim Abdool Karim, head of the Centre for the AIDS Programme of Research in South Africa (Caprisa), echoed this sentiment, emphasising that South Africa should strive for financial independence in its HIV response. He said it is not the responsibility of American taxpayers to look after our patients.
However, he criticised the abrupt withdrawal of US support, which left no time for proper planning. The funding cuts have also affected HIV research efforts, including a million grant from USAID to the Brilliant Consortium for HIV vaccine development, which has now been suspended.
Karim added that no other institutions can provide as much money as USAID for this, except perhaps the Gates Foundation.
Government plans to mitigate the crisis
In his recent budget speech, Finance Minister Enoch Godongwana did not allocate additional funding to address the shortfall. Before deciding on further allocations, the Treasury is awaiting an audit of Pepfar spending, which is expected to be completed by the end of the month.
In response to the crisis, Motsoaledi instructed provincial health heads to implement emergency plans, including:
- Providing three- to six-month supplies of ARVs for stable patients
- Shifting healthcare staff from less busy departments to address shortages
- Ensuring continued support for high-risk patients
Healthcare experts warn of service disruptions
Dr Linda Wilkinson from the University of Cape Town’s School of Public Health warned that the impact of these funding cuts goes beyond salaries. Critical services, such as HIV testing, pre-treatment support, and PrEP programs, were disproportionately funded by US institutions and are now severely disrupted.
As the government scrambles to fill the funding gap, patients and healthcare workers remain in limbo. With over 5.7 million South Africans relying on ARVs, ensuring continuous supply and access to care is essential to prevent drug resistance and worsening health outcomes.
While experts agree that South Africa should strive for self-reliance, the immediate reality is a looming crisis unless swift action is taken to replace lost funding and safeguard HIV treatment programmes.