Health experts warn of ‘huge disaster’ as USAID terminates Pepfar HIV funding in SA

Health experts and activists have raised alarm over the termination of Pepfar (President’s Emergency Plan for Aids Relief) funding in South Africa, warning that the decision could lead to hundreds of thousands of deaths and new HIV infections, while undoing decades of progress in the fight against HIV/Aids.

In a press briefing held on Thursday, healthcare professionals and community leaders detailed the far-reaching consequences of the funding cuts, describing them as potentially catastrophic for HIV prevention and treatment services across the country.

Pepfar funding freeze background

Professor Linda-Gail Bekker, chief operating officer of the Desmond Tutu HIV Foundation, explained that Pepfar was established in 2003 to address the Aids crisis in the global South.

Over 25 years, the programme has saved millions of lives and prevented countless infections.

“It’s important for us to reflect about the President’s Emergency Pepfar fund. It was first instigated in 2003 in response to the fact that people in the global South were dying of Aids despite the fact that there was life-saving treatment to change that life course,” Bekker said.

She noted that South Africa had gradually assumed more responsibility for its HIV response, with approximately 80% now funded through national resources.

However, the remaining 20% Pepfar contribution remains critical for reaching key populations and achieving epidemic control.

“The Pepfar response now, the 20% that has been much talked about in the last month or so, is critical for helping us bring that epidemic to its knees,” Bekker explained.

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Pepfar funding freeze: Immediate impact and projected losses

According to Bekker, modeling studies suggest dire consequences if the funding gap isn’t addressed promptly.

“Over a 10-year horizon, whilst there may be some cost saving in the short term, in the longer term we will lose money,” she warned.

“We stand to lose all the investment over the last 25 years if we do not work hard to fill the gaps that this funding freeze is causing. Secondly, we will see lives lost. So, in excess of half a million unnecessary deaths will occur because of the loss of the funding and up to a half a million new infections.”

The termination orders followed initial stop-work orders that had been temporarily mitigated by waivers issued by US Secretary of State Marco Rubio to allow life-saving therapy and prevention of vertical transmission to continue.

However, within the last 24 hours, many USAID implementing partners received final termination notices.

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Critical gaps in healthcare services

Public health expert Lynne Wilkinson detailed how the funding cuts will affect specific healthcare services, emphasising that Pepfar funding wasn’t duplicating government services but complementing them by focusing on hard-to-reach populations.

“This wasn’t duplication of government services; it was complementary, providing that final push to achieve those 95 targets and reduce our infections and our HIV and TB mortality,” Wilkinson said.

“This is the entire HIV and TB programme put at risk of unraveling across public sector facilities, communities and key population services.”

The specific impacts include limited data capturing, reduced HIV testing, diminished treatment literacy and adherence support, and the potential elimination of pre-exposure prophylaxis (PrEP) services for high-risk individuals.

“We have limited support for advanced HIV disease services. These are high-risk patients, including high-risk pregnant women, who are left without specialised care clinics,” Wilkinson explained.

“We risk a cessation of PrEP services. This is for adolescent girls, young women, and pregnant women who will lose their critical HIV prevention tools.”

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Impact on community monitoring and vulnerable populations

Sibongile Tshabalala, National Chairperson of the Treatment Action Campaign (TAC), explained how the funding freeze affects community-led monitoring systems that have been instrumental in improving HIV services.

“Since 2018, TAC has developed, working with the PHID sector, a community-led monitoring system that is known by Ritchie, and we are systematically collecting data in clinics,” Tshabalala said.

She emphasised that this data collection has facilitated community-owned solutions and accountability meetings that have improved services for people living with HIV.

The funding cuts are particularly devastating for key populations who already face stigma and discrimination in mainstream healthcare settings.

Kholiswa Malahleha from the sex worker movement Sisonke described the emotional toll of the funding cuts.

“I’ve been having sleepless nights these days lately because I’m also trying to think how best we can save our communities because we know that some of the government health facilities are very discriminatory,” Malahleha said.

“This blow, it has actually reminded us of back then when HIV, there was no cure for that. So, it’s very concerning and alarming.”

Meanwhile, Aurora from the Aurora Colleges of Movement highlighted the particular challenges faced by transgender individuals who rely on Pepfar-funded clinics for gender-affirming care.

“As a client myself… at the clinic that provides gender-affirming care, it is very affecting that our medication is now interrupted,” Aurora stated, explaining that interruptions in medication can lead to “de-transitioning and psychological trauma.”

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‘We can’t afford to die’ – Call for government action

Speakers unanimously called for immediate government intervention to fill the funding gaps and prevent a public health disaster.

“It’s time now; government must act up and speed up the implementation plan to close the gap,” urged Tshabalala.

“We are calling for our government to step up and do something about what is happening. We can’t afford to die.”

Tshabalala added that they could not “afford to go back to those years where we are suffering with access to services.”

Bekker similarly appealed to the South African government: “I look to our own South African government urgently to say, ‘How do we fill the gaps so that lives are not lost, infections are not incurred?’ because we have been caught sleeping at the wheel.”

Wilkinson outlined specific steps the government should take: “Government must urgently develop a short-and-medium-term plan, including emergency funding allocations to sustain the service delivery, redeployment of trained healthcare workers and community staff to ensure the continuity of care, and a national coordination mechanism.”

“It is not hyperbole to say that I predict a huge disaster, a walk back on the investment unless other resources can be found and found urgently,” said Bekker.

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Government planning

Health Minister Aaron Motsoaledi previously revealed that the US government had initiated a 90-day review period of Pepfar funding.

“The assessment by the US government, not us… They say they are going to assess whether the programme they are funding, not only in South Africa, all over the world, is in line with the values and the beliefs and objectives of the American people and American government,” Motsoaledi explained.

The minister disclosed that initial discussions had occurred with US officials, complicated by the absence of an American ambassador in South Africa, with only a chargé d’affaires currently serving in that capacity.

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