US shutdown of HIV/Aids funding ‘could lead to 500,000 deaths in South Africa'

The Guardian

28-02-2025

Sweeping notices of termination of funding have been received by organisations working with HIV and Aids across Africa, with dire predictions of a huge rise in deaths as a result.
After the US announced a permanent end to funding for HIV projects, services across the board have been affected, say doctors and programme managers, from projects helping orphans and pregnant women to those reaching transgender individuals and sex workers.
The cuts could result in 500,000 deaths over the next 10 years in South Africa, modelling suggests, while thousands of people are already set to lose their jobs in the coming days.
The US government has announced it will be cutting more than 90% of the contracts of its key development agency, USAid, and slashing $60bn (£48bn) of overseas aid spending.
The Guardian has heard that notices of termination have been sent to organisations in other countries in the region, including Malawi, Zambia, Tanzania and Zimbabwe, as well as with the joint United Nations programme UNAids.
The Elizabeth Glaser Paediatric Aids Foundation said it had received termination notices for three of its projects, which provide HIV treatment for more than 350,000 people in Lesotho, Eswatini and Tanzania. The figure includes more than 10,000 HIV-positive pregnant women, who must continue taking antiretroviral drugs to avoid passing the disease on to their babies.
Dr Lynne Mofenson, a senior adviser at the foundation, said the decision was 'a death sentence for mothers and children'.
Many projects had been forced to stop work in late January after the Trump administration announced a 90-day review of foreign aid. A few were then granted temporary waivers to continue on the grounds that they provided life-saving services, before receiving notices on Thursday instructing them to close their doors permanently.
Projects funded by the President's Emergency Plan for Aids Relief (Pepfar), founded by George W Bush in 2003, appear to be particularly affected. In South Africa it funds 17% of the HIV response; in other countries the figure is much higher.
Prof Linda-Gail Bekker, director of the Desmond Tutu HIV Centre at the University of Cape Town, said: 'It is not hyperbole to say that I predict a huge disaster.'
Bekker has worked on modelling suggesting a complete loss of Pepfar funding in South Africa would lead to more than 500,000 extra HIV deaths over a decade.
It comes at a time when scientific breakthroughs, such as the introduction of long-acting injectable prevention drugs, meant many working in the HIV field had hoped an end to the disease might be in sight.
Now, said Bekker, it was likely things would go backwards. South Africa has about 8 million people living with HIV, the highest number globally.
She said she had initially expected the US to target programmes working with key groups of people such as the LGBT+ community, because of the Trump administration's attacks on diversity initiatives, 'but in fact, this has been across the board.
'This is children, this is orphans, vulnerable children, young women and girl programmes. It is generic and across the board.'
It also halts ongoing research, including trials into potential HIV vaccines and new prevention drugs, Bekker said.
US funding had allowed projects to fill gaps in government provision, such as clinics where transgender people or sex workers can seek care without stigma or legal concerns, Bekker said.
Kholi Buthelezi, national coordinator at Sisonke, a sex workers' organisation, said: 'I've been having sleepless nights. This blow, it reminded us of back when there was no cure for HIV.'
At a press briefing on the cuts, she and others working on HIV in South Africa called on their government to 'step up' and fill the gaps left by the US's withdrawal.
Pepfar funding has been distributed via USAid and the US Centers for Disease Control and Prevention (CDC).
Programmes with funding from the CDC have not yet been forced to shut, said Dr Kate Rees, a public health medicine specialist at the Anova Health Institute, but said it was too early to conclude that those programmes were safe.
There had already been plans to shift programmes reliant on donors to government funding over the next five years, Rees said, but 'now, instead of a careful handover, we're being pushed over a cliff edge'.
US funding had been embedded in the health system, she said, and so the withdrawal would 'be felt by everyone who uses or works in health services'.
Anova has received a termination notice. 'Tomorrow we are letting go more than 2,800 people,' Rees said. 'That's counsellors, data capturers, healthcare workers – and these people are not going to find other jobs very easily.'