US President Donald Trump signs executive orders in the Oval Office of the White House in Washington, DC, on January 20, 2025. (Photo by Jim WATSON / AFP)
The shutdown of USAID and the US President’s Emergency Plan for Aids Relief-funded clinics in South Africa has sparked serious concerns about the future of HIV treatment and adherence.
US President Donald Trump has issued an executive order to stop foreign help, affecting Plan for Aids Relief (Pepfar) funding from going to clinics, hospitals and other organisations in low-income countries.
South Africa has received more than R8 billion to fight HIV/ Aids through Pepfar since its inception in 2003.
The Treatment Action Campaign’s Anele Yawa said this decision could result in a spike in new HIV infections.
“What’s happening is a global crisis, which negatively impacts our response to HIV and Aids.
“Some access their treatment at health care facilities, while others rely on external pickup points.
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“Now, at clinic level, we face a dire shortage of human resources. It means our clinics will be congested as people previously relying on external pickup points, like pharmacies in malls, return to clinics. This will strain an already overburdened health care system,” he said.
South Africa has about 5.8 million people living with HIV who are on treatment. Yawa said treatment adherence was a major concern, as South Africa was already struggling with meeting its UNAID 95-95-95 targets.
The decision by the US government is part of a broader freeze on foreign aid initiated last week including Pepfar, the global health programme started by George W Bush. The stop work order comes as the US government evaluates its foreign aid.
“As we speak, about 1.1 million people living with HIV are disengaged from treatment. This number could increase as people face long waiting hours at clinics, leading to frustration and potential treatment default,” Yawa said.
He said most district implementing partners had begun laying off their staff. At least 20 000 people will be laid off due to the decision.
South Africa relies on Pepfar for 20% of its HIV budget, while some low-income countries are almost entirely dependent on the programme.
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The Wits RHI Trans Health Centre, which also offered treatment to key populations, was on Monday among the affected service providers forced to shut its doors.
The Ivan Toms Centre for Men’s Health in Cape Town also issued a notice halting its services. Engage Men’s Health clinics in Johannesburg, Buffalo City and Nelson Mandela Bay all closed their operations.
Dean of Wits University’s faculty of health sciences Prof Shabir Madhi said it was difficult to gauge the impact of the stop orders on South Africa’s health programmes.
“Many of these programmes are actually integrated in government facilities.
“What we hope will happen is that government steps in to address the disruption because of the stop work orders that have been issued.
“This means staff currently employed through the US-funded grants, the activities of those staff, will need to be shifted to government employees.”
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Foster Mohale, health department spokesperson, said the department was still assessing the situation.
“We will communicate the implications and contingency plan. At the moment, it is difficult to respond to questions as the assessment process has just started.”
Sisonke communications officer Yonela Sinqu raised the alarm for key population groups. Sisonke is the national sex workers movement.
“A number of our members are going to regress in treatment adherence, which was encouraged by these clinics. These clinics were taking services to members directly through mobile clinics.
“Our members are reluctant to visit community health facilities as they are often ill-treated there. Hence their preference for donor-funded clinics that treat key population groups with dignity.”
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