Johannesburg – South Africa's battle against HIV/Aids has been dealt a devastating blow as drastic cuts to US funding force the closure of vital programmes, leaving vulnerable patients at risk and jeopardising years of progress.
The grim reality of the situation is exemplified by the case of an HIV-positive mother from Limpopo, who, after giving birth to a healthy baby, now faces the heartbreaking prospect of transmitting the virus to her son through breastfeeding. This mother was a beneficiary of the Anova programme, one of the largest HIV/Aids projects in the country, which was forced to shut its doors almost overnight.
Natasha Davies, an HIV specialist at the Anova Health Institute, paints a bleak picture of the consequences. "Her supply of medication is going to run out. She can get it in Limpopo, but the paperwork is a problem. Our networks have collapsed," she laments. The mother, who had previously received antiretroviral treatment in Gauteng to manage her viral load, had returned to Limpopo after losing her job, highlighting the complex socio-economic challenges intertwined with the HIV/Aids epidemic.
"I am exhausted, sad, frustrated, and furious," says Davies. "The sector has been wiped out overnight. I haven't been able to work for the past four weeks and am worried sick about my patients."
The crisis unfolded rapidly. HIV/Aids projects in South Africa, employing approximately 15,000 workers paid by USAID and Pepfar, were already struggling after US funding was frozen for 90 days in late January. Last week, the axe fell, with organisations receiving terse letters from Washington.
The letters stated: "Your project is not aligned with the agency (USAID)'s priorities, and a decision has been made that it is not in the national interest (of America). Cease all activities immediately, terminate all contracts and incur no further costs."
Adding insult to injury, some of the letters were signed off with the words "God bless America," according to another researcher, who is now in the process of laying off 700 workers who served about 350,000 patients across three projects. The researcher, who wishes to remain anonymous to protect limited funding from other American institutions, described the letters as "callous" and said the suddenness of the decision left no time for planning.
The impact of these cuts is far-reaching. Lynne Wilkinson, a public health specialist, emphasises the crucial role of American funding in managing the epidemic, particularly in the areas of counselling and testing. While the state funds around 83% of South Africa’s health budget for HIV/Aids, the US funds are vital for reaching communities and ensuring people are tested and linked to treatment.
"If we are not in communities to test people and then get them on medication, it will affect the whole system," warns Wilkinson.
South Africa currently has approximately 8.5 million people living with HIV/Aids, with around 6 million on treatment. Despite progress, the country still records about 150,000 new infections and 50,000 Aids-related deaths annually.
Sibongile Tshabalala, chairperson of the Treatment Action Campaign (TAC), expresses shock and frustration at the Americans' withdrawal. "The impact is enormous. We are shocked and frustrated. We urgently need a plan," she says.
The staff funded by USAID were largely deployed in state clinics and hospitals, supplementing existing personnel and easing the burden on the healthcare system. Tshabalala notes that the freezing of funds has already led to longer queues and delays for patients. "Patients are already waiting much longer in queues (due to the recent freezing of funds). They now have to return on a second day for blood tests, for example," she says. This increases travel costs, time away from work, and the risk of patients defaulting on treatment.
The cuts have also brought medical research on HIV/AIDS to a standstill. Leila Mantoor, head of the Matrix project at the University of KwaZulu-Natal, says they are "stunned" and unable to consider alternative funding options yet. Her project, which was researching ways to prevent unplanned pregnancies and HIV infection in Mafakathini, has been abruptly halted.
Furthermore, USAID's decision to discontinue the $45 million (about R829 million) Brilliant Consortium, a programme aimed at developing an HIV vaccine across nine African countries, represents a significant setback for scientific progress.
Tendani Tsedu, spokesperson for the South African Medical Research Council (SAMRC), confirms the programme's discontinuation. "The hope for an HIV vaccine has been cut short along with plans to expand research capacity with new laboratories, clinical trial capacity, and scientist training," Tsedu says.
Professor Linda-Gail Bekker, head of the Desmond Tutu HIV Centre at the University of Cape Town and a manager of the vaccine project, reveals that they had made significant progress, with immunogenic molecules ready for clinical trials. "We have the first immunogenic molecules ready in the (laboratories') fridges for the first clinical trials. That’s now going in the bin," she laments. "The chances for a vaccine and the scientific knowledge alongside are being flushed down the drain, but we are not giving up. We are looking for other funders."
Davies emphasises the broader implications of the funding cuts, highlighting the impact on research capacity and infrastructure. "This setback is even larger than HIV/Aids; it also concerns the research capacity and facilities being created," she says. "When the Covid-19 pandemic struck, we had the institutions and expertise to make a significant contribution to testing, identifying, and treating the virus. What will happen with the next pandemic?"
Karl le Roux, DA MP and a health spokesperson, acknowledges the US's generosity over the past two decades, during which it has contributed around R145 billion to combatting HIV/Aids in South Africa. However, he stresses the need for the South African government to find ways to compensate for the sudden loss of funding. "We (the South African government) must now carefully look at where we can save or shuffle money to compensate for this," he says.
The health department has issued directives on the management of HIV/Aids services in response to the crisis. However, Tshabalala argues that measures such as providing stable patients with six months' worth of medication instead of three are problematic, given the existing pressures on provincial health departments' budgets.
Foster Mohale, spokesperson for the health department, says Health Minister Aaron Motsoaledi is liaising with provincial health authorities on how to handle the situation. "We are waiting for the minister to outline the plans at the right time," he says.
As the dust settles, South Africa faces a daunting challenge in mitigating the devastating impact of the US funding cuts on its HIV/Aids response. The future of countless patients, research initiatives, and the country's overall progress in combating the epidemic hangs in the balance.
