South Africa’s fight against HIV/AIDS continues unabated, despite the unexpected halt in US funding, Health Minister Dr Aaron Motsoaledi has assured the nation.
This decision, impacting numerous countries, sent ripples of concern through the global health community, particularly in nations heavily reliant on this crucial support. However, Motsoaledi, speaking at the Cabinet Lekgotla in Pretoria on Wednesday, 29 January, delivered a message of reassurance to South Africans living with HIV.
"We are buying ARVs on our own; our biggest problem will be the salaries and operational costs. That's what we are trying to look at with treasury," the Minister stated firmly, addressing concerns about the potential impact of the funding freeze. He clarified that while the US President’s Emergency Plan for AIDS Relief (PEPFAR) contributes significantly, South Africa's robust national programme, bolstered by the Global Fund, ensures the continued availability of antiretroviral treatment (ARVs). "The rest comes mostly from our fiscus and some other funders; PEPFAR is helping us in 27 districts out of the 52," he explained.
The Minister emphasised the scale of South Africa's HIV/AIDS response, highlighting the sheer number of individuals involved in the fight against the pandemic.
"We have an army of 271 606 people in the 27 districts fighting HIV and AIDS. 256,452 are funded by us as South Africa through our own fiscus. That leaves us with 15 145 people … those are the ones that will be affected by any withdrawal," Motsoaledi detailed, underscoring the limited direct impact of the US funding suspension.
He stressed that the primary concern stemming from the funding cut is not the supply of ARVs themselves, but rather the potential disruption to the salaries and operational costs of the 15,145 health workers whose positions rely on PEPFAR funding. The Department of Treasury has been tasked with addressing this shortfall.
The Minister's statement directly addressed the anxieties of millions of South Africans living with HIV. "The South African government, together with a small portion of funds from the Global Fund, finances the bulk of prevention and care programmes," he confirmed, assuring the public that the government is committed to maintaining the existing level of care. He further stressed the importance of adherence to treatment, urging citizens not to interrupt their ARV regimens under any circumstances.
"As the South African government, one thing that we want to make sure is that nobody should stop taking their ARVs because that will be devastating and completely dangerous,” he said, underscoring the critical importance of consistent medication for those living with HIV.
Despite the Minister's assurances, the situation remains fluid. "So far, we have not received a letter from the American government," Motsoaledi revealed, highlighting the lack of formal communication from the US government regarding the funding changes.
"These funds for the HIV/AIDS programmes come through the National Treasury and they have not received a letter; the Department of Health and the Department of International Relations and Cooperation (DIRCO) have also not received a letter. We have tried to contact the US embassy, but we couldn't get them. The NGOs and the clinics that are funded by PEPFAR are the ones which have received letters," he added, indicating that official confirmation of the funding cut is still pending at the highest levels of government.
The news of the potential funding cuts has sparked widespread concern and prompted action from various sectors. Political parties, including the Democratic Alliance (DA) and Build One South Africa (Bosa), have issued strong statements urging the US government to reconsider its decision. DA MP Emma Louise Powell highlighted the critical role PEPFAR plays in sustaining life-saving treatment and support services for millions of vulnerable South Africans.
“In 2024, South Africa benefited from $453 million in direct funding, with roughly $439 million allocated for 2025. This funding is critical to sustain life-saving treatment for South Africans, as well as support services for babies and orphans,” she stated, emphasizing the devastating consequences of a sudden funding cessation. She also pointed out the transformative role PEPFAR has played since 2003, saving millions of lives and strengthening South Africa's public health infrastructure.
Bosa leader Mmusi Maimane echoed these sentiments, announcing his party's intention to formally petition President Trump to reverse the decision. “South Africa is home to the largest HIV epidemic in the world, with over 8 million people living with HIV. PEPFAR funding has been instrumental in providing life-saving antiretroviral treatment, preventing mother-to-child transmission of HIV, and supporting community-based healthcare systems that are the backbone of the country’s HIV/AIDS response,” he said, highlighting the devastating consequences of halting this vital support. He stressed that the decision is not merely a health issue but a social justice issue affecting the most vulnerable members of society.
The impact extends beyond the purely numerical. The Gender and Sexuality Alliance in Buffalo City, Eastern Cape, highlighted the disproportionate impact on the LGBTQIA+ community, where access to life-saving healthcare services, including hormone therapy for transgender individuals and essential HIV prevention and treatment, is now severely compromised.
“These services are not mere privileges; they are fundamental human rights. Denying access to them is a flagrant violation of international human rights standards and reinforces the systemic inequalities we are committed to dismantling,” the organisation stated, emphasizing the broader human rights implications of the funding cuts.
Minister Motsoaledi expressed his bewilderment at the US government's decision. "We have been fighting the scourge of HIV and malaria together for more than 20 years as a global community and depending a lot on global funding," he said, highlighting the long-standing partnership between South Africa and the US in combating these diseases. He stressed, however, that South Africa remains committed to its own robust HIV/AIDS response. "But on the South African side, as you know, we are running the world's biggest HIV counselling and testing campaigns," he added, emphasizing the country's unwavering dedication to tackling the epidemic.
The situation remains complex, with the interplay of national budgets, international aid, and the urgent needs of millions of South Africans living with HIV. While the immediate impact of the funding cut may be limited due to South Africa's substantial investment in its own HIV/AIDS programme, the long-term consequences remain uncertain.
