Dangerous fantasy: US ambassador Dybul said SA was ready to transition off Pepfar. It wasn't
In April, Ambassador Mark Dybul, a former Global Fund chief and key architect of the US President's Emergency Plan for Aids Relief (Pepfar), told the US Congress that South Africa could 'easily transition' from American HIV support within 12 months. It was a neat soundbite, delivered with the polished assurance of someone who has spent years navigating donor boardrooms. But it was also a dangerous fiction, one that we are now watching unravel in real time.
Because South Africa cannot go it alone. And despite the minister of health's insistence that the gap is being closed, thousands of people are already falling through it.
At the time of Dybul's statement, many in South Africa's HIV sector warned that such an accelerated transition, especially one not backed by an inclusive, resourced plan, would lead to devastation. Those warnings were dismissed as alarmist. Yet today, viral load testing is in decline, trusted clinics are closing, and thousands of health workers have been terminated. Sisonke, the national sex worker-led movement, has shut down its mobile HIV clinics. Anova Health Institute, which pioneered MSM-accessible services, has lost its lifeline. Community-based organisations, already operating at the edges of burnout, are being forced to scale back or shutter. This is not a theory. This is collapse in motion.
There is a particular kind of harm caused by high-level optimism detached from ground-level truth. When someone like Dybul tells Congress that South Africa is 'ready,' that narrative travels. It echoes in donor reviews, funding allocations, and strategic plans. It creates political cover for disengagement. And it reinforces the deadly idea that once money has been invested, moral and practical responsibility ends.
But HIV doesn't respond to spreadsheets. And South Africa's overburdened public health system cannot carry the full weight of this response alone, particularly not for the communities that have always been the most criminalised, stigmatised, and underserved.
It's not just that the funding was cut. It's that our own government has failed to step in.
As Bhekisisa recently reported, the South African government's response to this crisis has been one of denial, deflection, and delay. The health minister has downplayed the severity of the situation and accused civil society of peddling panic. Meanwhile, activists, health workers, and people living with HIV are the ones shouldering the fallout, with fewer services, fewer options, and fewer lives saved.
To suggest that South Africa is independently filling the gap left by Pepfar is not just disingenuous, it's deadly.
The impact on key populations is immediate and catastrophic. Sex workers, LGBTQ+ people, migrants, and people who use drugs already face hostility within public healthcare settings. They have depended on donor-funded, community-led initiatives not just for services, but for safety. When those programmes disappear, there are no public equivalents waiting in the wings. There is only the void, and the violence of being made invisible again.
Without dedicated funding, programmes tailored to these communities have always struggled. Conservative gatekeepers have used moral panic to obstruct local support, leaving many initiatives in perpetual financial precarity. Now, without international investment, they are not just under threat, they are being erased.
What is happening in South Africa is not transition. It is abandonment dressed in the language of efficiency. It is donor fatigue hidden behind 'local ownership.' It is austerity disguised as empowerment. We need to call this moment what it is: a reckoning.
If South Africa is to truly own and sustain its HIV response, then our government must act with urgency, transparency, and humility. That means fully funding civil society partners. It means protecting and scaling up programmes that serve criminalised groups. It means ending the performance of readiness and facing the reality of fragility.
And to global donors: solidarity doesn't end when the press release goes out. If you say you care about health justice, then you cannot disappear at the hardest moment and call it strategy.
Dybul's statement to Congress may have come from a place of strategic optimism. But optimism, when weaponised against evidence, becomes a tool of harm. His claim was not just inaccurate, it gave donors permission to walk away and governments cover to do nothing. It created a fantasy of resilience while the system crumbled underneath it. And now, the people who fought for their right to health are being left with nothing but press briefings, vague promises, and shuttered clinics.
South Africa cannot go it alone, not yet. And pretending otherwise has cost us too much already.
Tian Johnson is the founder and strategist of the African Alliance, a Pan-African health justice nonprofit.
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