A volunteer demonstrates an HIV screening test. (File photo)
Patients using services rendered by projects funded through the United States Agency for International Development (USAid) have been forced into the already overburdened state healthcare system after President Donald Trump cut aid to South Africa, citing in part what he described as discriminatory legislation against whites.
President’s Emergency Plan for Aids Relief (Pepfar) organisations that receive funds through the US’s Centers for Disease Control and Prevention have been reinstated after an American judge enforced a temporary restraining order blocking Trump’s administration from freezing state grants.
But organisations such as the Treatment Action Campaign (TAC), an HIV/Aids activist organisation, warned this week that Trump’s ban on aid had already created an “unprecedented crisis” for people living with, and affected by, HIV and TB.
“The US government’s funding freeze is wreaking havoc across vital healthcare services in South Africa, creating an unprecedented crisis for people living with and affected by HIV and TB,” the TAC said.
“The reckless freezing of US foreign aid is nothing short of a death sentence for thousands of people in South Africa.
“Critical healthcare infrastructure is being dismantled, clinics forced to close, frontline workers without support — all while lives hang in the balance. We are watching decades of progress on HIV being decimated,” the TAC’s chairperson Sibongile Tshabalala added.
As of last month, 5.5 million South Africans were taking antiretroviral (ARV) drugs to treat HIV. This is out of an estimated 7.8 million people in South Africa who are HIV positive.
Pepfar had committed $439 537 828 to South Africa for the current US financial year running from 1 October to 30 September. The money is mainly channelled to projects and the department of health through the Centers for Disease Control and Prevention and USAid.
Gauteng has the highest proportion of Pepfar-funded staff, with 8% of its HIV response workers supported by the programme, followed by Limpopo at 7%, Health Minister Aaron Motsoaledi told reporters earlier this month.
The North West, KwaZulu-Natal and the Eastern Cape each have 5% of their staff funded by Pepfar, while in the Western Cape, Mpumalanga, and the Free State, the plan supports 4% of the workforce.
Beyond the provincial staff, 220 at the national level had lost their jobs, including 24 staff working through private clinics and civil society organisations, Motsoaledi said.
In a country already grappling with high unemployment of over 30%, Motsoaledi said 15 000 jobs in South Africa’s health sector had been affected by the ban.
“Our biggest problems will be the salaries and the operational costs. That is what we are looking at with the national treasury,” he said.
At least 9 000 drug addicts have lost access to needle-exchange and opioid-substitution therapy in Mpumalanga, Limpopo and Gauteng since the ban, according to a survey conducted by the South African National Aids Council Civil Society Forum at clinics.
Trump’s aid cut has also hit clinical trials. The South African Medical Research Council, which was awarded $45 million to develop and test HIV vaccines in Africa last year, said this week the suspension of funding through USAid had delayed its critical HIV vaccine research.
“The search for an HIV vaccine remains one of the most urgent global health challenges.
“Any delays in this work impact millions of lives worldwide.
“We are committed to engaging with all stakeholders to ensure that this important research can resume as soon as possible,” the council’s head of communications, Tendani Tsedu, told the Mail & Guardian.
At the Helen Joseph Hospital in Johannesburg, clinicians said the withdrawal of funding had slashed basic HIV counselling services, the TAC said this week.
“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] — and there’s no counselling at all,” it quoted a hospital source as saying.
“Occasionally, one of the few overburdened nurses manages to do a test but it’s inconsistent and unsustainable. The most vulnerable are being missed and lives are being lost,” they said.
A patient, who spoke to the M&G outside the University of Witwatersrand Reproductive Health and HIV Institute (Wits RHI) clinic in Hillbrow, said he was surprised to find the clinic had closed after he made the hour-long journey to collect his pre-exposure prophylaxis (PrEP) on Tuesday.
The drug is taken by people who are HIV negative but at high risk of exposure to the virus.
“The treatment I would get at Wits RHI was convenient, the staff were always ready to assist and it was an overall good experience. Now, I have to change to a public clinic that I am sure will not have the same attitude towards me,” the man said.
Joburg Child Welfare has been forced to retrench 35 workers from eight clinics across Gauteng that provide psychosocial support, trauma counselling, medical referrals and legal guidance to victims of gender-based violence and sexual offences after Trump’s move.
“It all happened overnight — our staff found themselves with no jobs,” the child welfare organisation’s assistant director Chriselda Bunu told the M&G. This had forced it to “downscale our operations at the clinics”.
Its gender-based violence programme was a beneficiary of funding allocated by USAid to the Networking HIV & Aids Community of Southern Africa.
In the past year, it has assisted 8 346 survivors of gender-based violence and sexual assault.
“The department of social development funds other programmes at the welfare but we will obviously have to look for funds now to keep the programme alive.
“We have been trying to secure funding from corporate social investment projects but we will also be approaching the government to see what we can do going forward,” Bunu said.
A Joburg Child Welfare employee said she was devastated when she was informed that she had abruptly lost her job and would not be able to support her three children.
“We do important work by providing essential services to women, men and children who are abused … we have patients coming in bleeding from their mouths.
“Tell me how services like that are suddenly rendered not necessary?” she told the M&G, in tears.
Activists fear, even if the US was to resume funding, the LGBTQIA+ community, a key population in tackling the wider HIV epidemic, would not be deemed a priority.
“We know Trump’s ideologies on the LGBTQIA+ community — the likelihood of related programmes being funded going forward is zero,” one said.
In South Africa, nearly 27% of men who have sex with men are living with HIV. The prevalence among transgender women is 63% in Johannesburg and about 50% in Cape Town and in Buffalo City, according to data from the International Aids Society.
The Engage Men’s Health project, which offered HIV and TB testing and supplied PrEP for HIV-negative patients in the Johannesburg, Nelson Mandela Bay and Buffalo City metros, has been forced to shut its doors.
Over the past five years, through Pepfar funding, the clinic has started 3 606 HIV-positive clients on antiretroviral therapy.
It said the “abrupt halt in services” would leave 5 000 of its beneficiaries without alternative options.
“The sudden disruption prevented us from adequately preparing clients for alternative options, leaving many without access to antiretrovirals and HIV-prevention services such as PrEP,” spokesperson Luiz de Barros told the M&G.
For sex workers, who are vulnerable to contracting HIV, this isn’t just a funding cut but a life-threatening crisis, National Sex Worker Movement of South Africa director Kholi Buthelezi said.
“The loss of US government funding has left sex workers without life-saving healthcare, HIV prevention, and critical support. Without these services, they face higher risks of violence, stigma, and disease — pushing them further into isolation and vulnerability,” Buthelezi said.
