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Daily Maverick
5 days ago
- Health
- Daily Maverick
Data drought: How funding losses are compromising South Africa's HIV response efforts
About 40% of the health workers who collected data in the country's HIV hotspots either lost their jobs in February or will be jobless in September, leaving a massive knowledge gap in their wake. Experts warn that not knowing what we don't know is dangerous. 'Picture the patient walking into the facility. The first person who greets them is the data capturer, who looks at their file. From there, the data tells the story of what should happen next,' says Moses Mashupye, who was a data capturer for the Anova Health Institute, working with public clinics in Capricorn District, Limpopo. 'You're the engine of the facility. You know where to refer people, track patterns, and raise red flags when needed.' Mashupye is one of 1,601 data capturers who lost their jobs when the Trump administration abruptly halted all Pepfar funding for HIV and TB projects through the United States Agency for International Development, USAid, in February. Another 1,421, funded through the Centres for Disease Control (CDC), are also likely to lose their jobs in September, when the US government's financial year ends. According to health department spokesperson Foster Mohale, USAid and CDC-funded data capturers account for about 40% of the workers who collected crucial HIV data in the country's HIV hotspots. The massive scale of these losses is likely to have a big impact on the quality and continuity of HIV data — leaving researchers, policymakers and activists without the information they need to make sense of the funding cuts and find solutions. The data collected ensured patients didn't fall through the cracks — Mashupye already knows of hundreds of patients who missed appointments for antiretroviral treatment (ART) or testing — and helped the health department monitor the disease. That missing information means guesstimates and anecdotes are driving key decision-making about the 7.9-million people living with HIV in the country. Now, much of that information is simply not being captured. Counting our data capturers Mohale says the data capturer jobs were lost in the 27 health districts where the US government funded projects and health workers. Together, those districts account for 82% of South Africa's HIV burden. At a press conference on 15 May 2025, Health Minister Aaron Motsoaledi said he was trying to fill that gap. Gauteng has hired and trained 75 data capturers, and North West has hired 173, and Mpumalanga 200. But that still leaves us thousands short. 'Data is at the heart of understanding where we are and what progress we're making, and what our problems are in making better progress,' said Salim Abdool Karim, director of the Centre for the Aids Programme of Research in South Africa (Caprisa), who says South Africa has an obligation to meeting its part of the United Nations' goal to end Aids as a public health threat by 2030. For this, countries around the world have halfway targets, known as the 95-95-95 goals, that need to be met by the end of 2025. South Africa needs to have 95% of all people with HIV diagnosed, and of those 95% need to be on antiretroviral treatment. Of those on antiretroviral treatment 95% need to have so little virus in their bodies that they can't transmit it to others; scientists call this being virally suppressed. Motsoaledi says South Africa is currently at the 96-79-94 mark. The second '95' is what we're so behind on; we're struggling to get people who know they have HIV on treatment and keep them on it. Data collection is central to identifying, then fixing gaps like these in HIV programmes. Which is why Pepfar spent more on data capturers than any other type of health workers in South Africa — about 12.5% of all salary funding — and that includes nurses, community health workers and lay counsellors. Skilled data capturers like Mashupye, who handled sensitive patient data and helped spot trends that shaped disease responses, earned about R10,000 to R14,000 a month, said Kate Rees, a public health medicine specialist at the Anova Health Institute. 'I think this is the nub of the problem,' said Linda-Gail Bekker, head of the Desmond Tutu Health Foundation, at a recent Bhekisisa and Southern African HIV Clinicians Society webinar about the impact of the funding cuts hosted by Bhekisisa and the HIV Clinicians Society. 'If you don't measure something, you won't even know that it's a problem. So, unfortunately, to date a lot of it has been anecdotal stuff.' Key populations guesstimates During our webinar Rees agreed. She said the lack of reliable data had forced guesswork. But from the data that is coming in, Rees is seeing 'key metrics rapidly deteriorate' — viral loads, CD4 counts, tests for young babies — when compared to last year. Viral loads and CD4 counts tell doctors how well HIV treatment works. 'We're seeing about a 30% decrease in people (in the City of Johannesburg) starting on antiretroviral therapy. We hope that that is mostly due to incomplete data capturing. The records are not being updated, but we don't know, and so it becomes incredibly difficult to monitor the programme.' Rees is also concerned that current government indicators don't adequately track groups of people with a higher chance of getting HIV — called key populations — such as sex workers, gay and bisexual men, people who inject drugs and transgender people. For the past 10 years, nearly half of new infections globally have happened in these groups. Every year, the UNAids Global Aids update shows why it's so important to put money into services for key populations. When new infections in those groups are reduced, it also slows down the spread of the virus in the general population. That's what is giving Kholi Buthelezi, national coordinator of the sex work movement Sisonke, sleepless nights. Pepfar funded 12 specialised clinics across the country. Now that those are gone, sex workers are being referred to state clinics where they face discrimination, making them reluctant to go there. Because of that, some have stopped taking anti-HIV pills that can stop infection or ARV treatments. But, she said during our webinar, without data there is no knowing the scale of the problem. The detail in the data The deputy director-general for National Health Insurance, Nicholas Crisp, says he isn't too worried about the missing numbers, and that the data tracking gap might be a blessing in disguise, a chance to create one system for the different ways in which donors require organisations to report it. But he warns things could worsen if CDC-funded data capturers also lose their jobs in September. 'I've got no doubt that there are going to be dents in the impact of what we're able to collect and report on, but exactly what and where and how, I can't really say. I think we would need to ask the people on the ground about that.' Fezile Mgxagxama had been working on the ground as a data capturer in Hillbrow for six years, when he too, lost his job overnight. He was one of eight data capturers Anova deployed to the fast-paced Esselen Street Clinic to support the government service to 20,000 people in the area. Just three state-employed data capturers remain. 'As it is, when we were together, the government capturers used to do about 20% of what we did per day,' says Mgxagxama. 'We used to pass our Pepfar training on to them to improve their productivity. Now, we have heard they are falling more behind, day by day.' To get reliable data for real-time decision making, Pepfar funded highly detailed data collection. This sort of expertise, from running programmes to managing the data, has taken decades to build, and experts say they aren't convinced the R2.82-billion to fill the funding gap left by Pepfar is going to cover the catch-up time that's going to be needed. When are you guys coming back? It was data that helped South Africa turn HIV dissidence on its head. In 2001, South Africa had little data on the proportion of people with HIV, and people were refused free treatment due to government denialism. But the Human Sciences Research Council's first national survey in 2002 was a turning point: it revealed that more than 11% of participants were HIV positive, showing the scale of the crisis and prompting action, as the Bhekisisa data team reported in December. Data has been quickly disappearing around the world as the Trump administration strips scientific data from US websites, including global Pepfar data, which means another reference point, historical data, has been lost to HIV disease trackers who figure out trends. Not having the Pepfar data reminds Mitchell Warren, the executive director of the New York-based HIV prevention organisation, Avac, of what Trump argued during the height of the Covid-19 pandemic: 'If we stopped testing right now, we'd have very few cases, if any.' Warren says this makes no sense. 'Pepfar's systems weren't perfect, but they were consistent and used to guide real-time decisions. Now, we're flying blind. So here's the choice: guess, spend money and hope. Or use data to drive smart, targeted decisions.' The data vacuum is what was worrying delegates in the corridors of last week's Interest conference in Windhoek. Researchers and HIV specialists at the Africa-focused HIV gathering were fearful that this would be the last time they saw the kind of detailed insight that has been generated by Pepfar-supported projects in the past, hindering their ability to guide the HIV response. But right now, say researchers like Bekker, the need to get into a room to set priorities and keep the hard-fought momentum going is what's urgent. 'We saw amazing leadership during Covid, right? And then private funding kind of followed in its wake. We're not hearing that this time around. And my concern is because it doesn't feel like anyone's in charge.' Mashupye and his patients are worried, too. He says patients are calling him on his personal cellphone every day and asking him: 'When are you guys coming back? Is there any feedback from Trump? Because we need you.' DM
Daily Maverick
15-05-2025
- Health
- Daily Maverick
South Africa's HIV treatment triumph faces new challenge — the rise of age-related illnesses
The success of South Africa's HIV treatment programme — the largest in the world — has also created a slumbering threat: a considerably larger group of people who need to be treated for age-related illnesses such as diabetes, heart conditions and high blood pressure — also called noncommunicable diseases — on top of having to receive HIV care. Because antiretroviral drugs (ARVs) keep people healthy and increase their life expectancy, the scale-up of treatment in South Africa — public sector treatment started in 2004 and in 2025 we've got about 6-million people on ARVs — means that most people with HIV and who take ARVs correctly now live just as long as those without the virus. Bhekisisa's data analysis shows the proportion of older people with HIV doubled over the past decade: people over 50 are now the second biggest HIV-positive group in South Africa today; 15 years ago, they were the smallest group. If this trend carries on, there could be three times as many HIV-positive people over 50 by 2030 as in 2015. As people age, their chances of developing health problems like high blood pressure, heart disease and diabetes rise, which means that people with HIV might live long lives, but not necessarily healthy ones. With nearly two-thirds of all people with HIV living in sub-Saharan Africa, the continent will keep on bearing the brunt of the epidemic — despite massive gains in curbing new infections over the past 15 years — if health systems aren't geared to handle a growing number of people who have both HIV and a chronic illness like heart disease or diabetes. Experts raised the alarm about this 'inevitable price of success' more than a decade ago. Yet, write the authors of an editorial in a March issue of The Lancet Healthy Longevity, without thorough data on older people with HIV in African countries, putting plans for their healthcare in place will be hard — or may not be done at all. And with many countries' governments, including South Africa's, scrambling to find the money to replace the thousands of data capturers for HIV programmes previously funded by the US government after the abrupt halt in aid, funds for tracking health conditions of older people with HIV will probably be a low priority. In the wake of funding cuts, employing health workers to capture and manage health data would be a hard sell, said Kate Rees, a public health specialist with the Anova Health Institute, during a webinar hosted by Bhekisisa and the Southern African HIV Clinicians Society on Thursday — something that, for a public health issue that might be ignored because its fallout isn't immediately visible — could just make the problem so much worse. What then, does South Africa's picture look like, and could policymakers focus forward to stave off a calamity in the making? Here's what the numbers show. Doubled in a decade The proportion of people with HIV and who are 50 or older is growing — and faster than increases in other age groups. In 2015, the count in the 50+ age group was just over 700,000, which translates to about 12% of the total HIV-positive population. The age group 40-49 years, though, was about 1.3 million strong, which works out to 22% of the total. A decade later, the 50-plus total had jumped by 1.15 million to reach 1.85 million, and they now make up roughly 24% of the total number of HIV-positive South Africans. Although the 40-49 group's total also grew by 1.15 million, proportionally they now make up 32% of everyone. In other words, the proportion of older people with HIV doubled in a decade, but the proportion of people 10 years younger grew only 1.5 times bigger — a result, experts say, of people with HIV living longer, new infections still happening in older people and fewer new cases in the younger group. If this trend continues, there could be three times as many HIV-positive people over 50 by 2030 as in 2015. Speeding up, changing ranks People over 50 are the second biggest HIV-positive group in South Africa today. Fifteen years ago, they were the smallest group. Around 2012, the 50-plussers moved up one rank, surpassing growth in the under-20s group. But the number of HIV-positive people between 35 and 49 grew rapidly — so much so that by around 2012 they overtook the group aged 20-34 and assumed top rank. In the following years, the 50+ group increased too: people moved out of their late forties and new infections in that age group continued. By 2026 — about 10 years since their previous rank jump — people over 50 will already have been the second biggest group of the HIV-positive population for some time. The 35-49 years group will keep on growing in the next five years, modelled data shows, albeit more slowly than before. Because people are living longer, the older group will grow too as people move into their fifties, and because it's been expanding for some time already, the group will edge closer and closer to top rank over the coming years. Living long, but not necessarily healthy This is where the warning lies. Data from 2020 shows that, when Covid-19 is ignored, one in seven deaths in people between 45 and 64 years old were due to health problems like heart attacks, stroke and high blood pressure that year. In comparison, only one in 20 deaths in that age group were linked directly to HIV. Above age 65, a quarter of deaths were from these conditions. So few were linked to HIV in this age group that, proportionally, it was hardly a noticeable concern. So, as the peak of the HIV-infected population shifts into an older age band, more and more people will probably have to be treated for noncommunicable diseases like heart conditions, diabetes, obesity and high blood pressure — on top of receiving HIV care. In fact, in a large study in Mpumalanga, in which most people were in their late 40s to early 70s, about half had at least two age-related illnesses. For example, in this sample of just over 5,000 people, six in 10 had high blood pressure, with it being more likely the older someone was. About 10% of women had bad chest pain, called angina (which happens when the heart doesn't get enough oxygen-rich blood), and up to 11% of people had high cholesterol. High blood pressure combined with high cholesterol is bad for your heart. It can damage your arteries, and especially those that supply oxygen-rich blood to the heart. In turn, this ups the chances for fatty plaques building up along the walls of the blood vessels. This narrows and stiffens the arteries, meaning blood pressure builds up even more and the chance of a blood vessel rupturing increases. High blood pressure can lead to angina or a heart attack because the heart muscle gets too little oxygen, and also cause a suite of other health problems called metabolic syndrome, which includes conditions like diabetes, stroke and heart disease. Age-related health problems like heart disease, diabetes and being overweight are often linked to inflammation. This is a natural response of the immune system when tissues are damaged, like when we get older. However, inflammation is even more common with HIV-infection — because of the body's immune response, damage caused by the virus itself and also the effects of ARV treatment — and studies have shown that people with HIV who are older than 50 have double the chance of having conditions like diabetes or high blood pressure than what is seen in younger HIV-positive people. 'In future, every clinic nurse will have to be Nimart trained,' said Ndiviwe Mphothulo, the president of the Southern African HIV Clinicians Society at last week's webinar. Nimart nurses — short for Nurse-Initiated Management of Antiretroviral Treatment — are specially trained in how to prescribe ARVs and how to manage long-term patients. But, experts say, the flip side is also true if South Africa is to deal with the ageing HIV epidemic: every Nimart nurse will have to be equipped to deal with noncommunicable diseases in this population too. DM
TimesLIVE
13-05-2025
- Health
- TimesLIVE
The proportion of people of 50+ with HIV has doubled in 10 years. What does that mean for healthcare?
The success of South Africa's HIV treatment programme — the largest in the world — has also created a slumbering threat: a considerably larger group of people who need to be treated for age-related illnesses such as diabetes, heart conditions and high blood pressure — also called noncommunicable diseases — on top of having to receive HIV care. Because antiretroviral drugs (ARVs) keep people healthy and increase their life expectancy, the scale-up of treatment in South Africa — public sector treatment started in 2004 and in 2025 we've got around 6-million people on ARVs — means that most people with HIV and who take ARVs correctly now live just as long as those without the virus. Bhekisisa's data analysis shows the proportion of older people with HIV doubled over the past decade: people over 50 are now the second biggest HIV-positive group in South Africa today; 15 years ago, they were the smallest group. If this trend carries on, there could be three times as many HIV-positive people over 50 by 2030 as in 2015. As people age, their chance for developing health problems such as high blood pressure, heart disease and diabetes rises — which means that people with HIV might live long lives, but not necessarily healthy ones. With nearly two-thirds of all people with HIV living in Sub-Saharan Africa, the continent will keep on bearing the brunt of the epidemic — despite massive gains in curbing new infections over the past 15 years — if health systems aren't geared to handle a growing number of people who have both HIV and a chronic illness such as heart disease or diabetes. Experts raised the alarm about this 'inevitable price of success' more than a decade ago already. Yet, write the authors of an editorial in a March issue of The Lancet Healthy Longevity, without thorough data on older people with HIV in African countries, putting plans for their healthcare in place will be hard — or not be done at all. And with many countries' governments, including South Africa's, scrambling to find the money to replace the thousands of data capturers for HIV programmes previously funded by the US government after the abrupt halt in aid, funds for tracking health conditions of older people with HIV will likely be a low priority. In the wake of funding cuts, employing health workers to capture and manage health data will be a hard sell, said Kate Rees, a public health specialist with the Anova Health Institute, during a webinar hosted by Bhekisisa and the Southern African HIV Clinicians Society on Thursday — something that, for a public health issue that might be ignored because its fallout isn't immediately visible — could just make the problem so much worse. What then, does South Africa's picture look like, and could policymakers focus forward to stave off a calamity in the making? Here's what the numbers show. Doubled in a decade The proportion of people with HIV and who are 50 or older is growing — and faster than increases in other age groups. In 2015, the count in the 50+ age group was just more than 700,000, which translates to about 12% of the total HIV-positive population. The age group 40—49 years, though, was about 1.3-million strong, which works out to 22% of the total. A decade later, the 50-plussers' total had jumped by 1.15-million to reach 1.85-million, and they now make up roughly 24% of the total number of HIV-positive South Africans. Though the 40—49 group's total also grew by 1.15-million, proportionally they now make up 32% of everyone. In other words, the proportion of older people with HIV doubled in a decade, but the proportion of people 10 years younger grew only 1.5 times bigger — a result, experts say, of people with HIV living longer, new infections still happening in older people and fewer new cases in the younger group. If this trend carries on, there could be three times as many HIV-positive people over 50 by 2030 as in 2015. Speeding up, changing ranks People over 50 are the second biggest HIV-positive group in South Africa today. Fifteen years ago, they were the smallest group. Around 2012, the 50-plussers moved up one rank, surpassing growth in the under-20s group. But the number of HIV-positive people between 35 and 49 grew rapidly — so much so that by around 2012 they overtook the group aged 20—34 and assumed top rank. In the following years, the 50+ group increased too: people moved out of their late 40s and new infections in that age group continued. By 2026 — about 10 years since their previous rank jump — people over 50 will already have been the second biggest group of the HIV-positive population for some time. The 35—49-years group will keep on growing in the next five years, modelled data shows, albeit more slowly than before. Because people are living longer, the older group will grow too as people move into their 50s, and because it's been expanding for some time already, the group will edge closer and closer to top rank over the coming years. Living long, but not necessarily healthy This is where the warning lies. Data from 2020 shows that, when Covid-19 is ignored, one in seven deaths in people between 45 and 64 years old were due to health problems like heart attacks, stroke and high blood pressure that year. In comparison, only one in 20 deaths in that age group were linked directly to HIV. Above age 65, a quarter of deaths were from these conditions. So few were linked to HIV in this age group that, proportionally, it was hardly a noticeable concern. 1 in 7 people die of heart disease after age 45. Image: Thembisa Project So, as the peak of the HIV-infected population shifts into an older age band, more and more people will likely have to be treated for noncommunicable diseases such as heart conditions, diabetes, overweight and high blood pressure — on top of receiving HIV care. In fact, in a large study in Mpumalanga, in which most people were in their late 40s to early 70s, about half had at least two age-related illnesses. For example, in this sample of just more than 5,000 people, six in 10 had high blood pressure, with it being more likely the older someone was. About 10% of women had bad chest pain called angina (which happens when the heart doesn't get enough oxygen-rich blood) and up to 11% of people had high cholesterol. High blood pressure combined with high cholesterol is bad for your heart. It can damage your arteries, and especially those that supply oxygen-rich blood to the heart. In turn, this ups the chances for fatty plaques building up along the walls of the blood vessels. This narrows and stiffens the arteries, meaning blood pressure builds up even more and the chance of a blood vessel rupturing increases. High blood pressure can lead to angina or a heart attack because the heart muscle gets too little oxygen, and also cause a suite of other health problems called metabolic syndrome, which includes conditions like diabetes, stroke and heart disease. Roughly 1.6-million people over 50 are on ARVs today. Image: Thembisa Project Age-related health problems such as heart disease, diabetes and being overweight are often linked to inflammation. This is a natural response of the immune system when tissues are damaged, like when we get older. However, inflammation is even more common with HIV-infection — because of the body's immune response, damage caused by the virus itself and also the effects of ARV treatment — and studies have shown that people with HIV who are older than 50 have double the chance of having conditions like diabetes or high blood pressure too than what is seen in younger HIV-positive people. 'In future, every clinic nurse will have to be Nimart trained,' said Ndiviwe Mphothulo, president of the Southern African HIV Clinicians Society at last week's webinar. Nimart nurses — short for Nurse-Initiated Management of Antiretroviral Treatment — are specially trained in how to prescribe ARVs and how to manage long-term patients. This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.
News24
29-04-2025
- Health
- News24
How this Limpopo NGO prepared itself for Trump funding cuts
The Anova Health Institute, which received the lion's share of the US President's Emergency Plan for Aids (Pepfar) funding in South Africa, had their funding halted in February along with dozens of non-profits throughout the country. Hlokomela Clinic in Limpopo was one of NGOs that relied on a grant from Anova, and had to cut back on their HIV programme, which tested 1 000 farm workers for HIV each month. The clinic group's founder, Christine Du Preez, told Bhekisisa how 20 years of hard lessons — with a dose of good luck and a lot of persistence - has helped them to prepare for such a crisis. When Sindy Nkuna woke up to an email saying that the United States had decided to temporarily freeze all foreign aid in January, it was scary. "I felt shattered," she said. "For days I had racing heartbeats thinking what's going to happen to me and to my kids. It was unbelievable. I have two boys." Nkuna had been placed at the Hlokomela Clinic, 200km away from Polokwane, keeping track of HIV information in the fruit and game farming community of the Mopani District Municipality in Limpopo. As a data capturer, she tracked new cases of HIV, how many people were tested and how many were on treatment. The funding for her job — and six HIV testing counsellors, a site coordinator and part of their financial manager's salary — came through a grant from the Anova Health Institute, the HIV organisation which received the most President's Emergency Plan for Aids (Pepfar) funding in South Africa. Pepfar is the US government's Aids fund that financially supports HIV projects, mostly run by non-profit organisations, in countries like South Africa. Nkuna sat at home anxiously waiting to hear if she would still have a job. At the end of February, word came that almost all USAID funding, which included many of the Pepfar-sponsored projects, would be permanently ended. Overnight Hlokomela was left without its HIV testing team that does fieldwork, and funding for equipment like cooler bags and transport costs for mobile testing clinics, all of which were paid for by Anova. HIV field services at the 50 sites across Hoedspruit farms and communities that helped test around 1 000 people for HIV every month were closed. "It affected all of our HIV outreach … it was worse than Covid," said Christine Du Preez, who founded Hlokomela in 2005. The team had to figure out how to make it work for its remaining staff — and the 25 000 farmers, workers and their families that depend on them for basic health services. But Hlokomela was far better equipped to deal with the crisis than many other organisations that also lost their USAID funding. Here's why the plans they've made - and the lessons they've learned in the past decade - are helping them get by. Use what you've got Hlokomela has three clinics, with nine mobile clinics that work in 72 sites across fruit and game farms. With 106 staff members, it employs paid nurses, data capturers, lay counsellors, community health workers and doctors who volunteer twice a week for free. The Anova funding — which made up 2% of Hlokomela's overall budget — paid for the mobile testing clinics and the staff who ran them. In 2008, 28.5% of farm workers in Hoedspruit had HIV, over 10 percentage points higher than the proportion of adults — 17.64% — who had the virus in South Africa in 2007, according to health department data. Du Preez said their latest data from this year shows that Hlokomela has helped the proportion of HIV-infected farm workers to drop to 6.5%. READ MORE | Game-changer: 6-monthly anti-HIV jab could end Aids in South Africa by 2032 But when their funding stopped, Hlokomela was caught by surprise. Since then, testing has dropped by nearly 90%, Nkuna said. Still, they made a plan. It's the community healthcare workers (CHW) — known as nompilos, "mother of life" in isiZulu — they've leaned into. Hlokomela has trained about 75 of these farm workers - who earn a monthly stipend - in health education as well as checking blood pressure and heart rates, and screening for chronic conditions such as HIV and TB. Because Hlokomela's funding for clinic staff was still intact, they could continue to test people for HIV at facilities. But someone had to tell people about it — and explain how to get there. The nompilos went around farms identifying people who needed to get tested, and encouraged them to go to Hlokomela's clinics. Hlokomela then also roped in seven volunteers, who were certified in HIV testing, from another one of their projects to help with the now higher numbers of people who needed to get tested at their clinics. Moreover, the project came up with a short-term fix to stop the backlog to capture testing data from getting too high. Nkuna was the only person trained to use the government's HIV database. That's why Hlokomela temporarily transferred two employees from its sex worker programme to help with recording health tracking data, said Antoinette Ngwenya, a Hlokomela programme manager. "The fact that we still have a clinic means that we can still do HIV testing. Because if we don't test and get them on treatment, we could have a boom of HIV again," said Du Preez. "Hopefully we will get another plan. It looks like the Discovery Fund is also going to help us to get the [HIV testing services] HTS going again." Don't put all your eggs in one basket About 10 years ago, Hlokomela learned a tough lesson: don't rely on a single donor; it poses a serious risk of an organisation collapsing when things go wrong with the funder. For 10 years, Hlokomela was mainly funded by the United Nations International Organisation for Migration (IOM). "When we had IOM, we could run many projects and have big events for campaigns. It was great," said Ngwenya. ALSO READ | How much does our HIV response depend on US funding? But then IOM's funding to Hlokomela ended in 2016, and the organisation had to start raising other funds. "We were worried we were going to close down. One of the challenges was realising there was funder fatigue, so we had to start thinking outside of the box," Du Preez said. "We found ways to make our own money, got our network of donors to help us find other funders and made an agreement with the provincial health department." The Limpopo Health Department signed a three-year agreement to pay stipends for Hlokomela's then 41 nompilos. Eight years later, Hlokomela is funded by grants from organisations like the Discovery Fund, the Aids Foundation South Africa via the Global Fund, the pharmaceutical company Adcock Ingram, and the Australian High Commission. They also get donations from individuals, businesses and lodges in the area. The provincial health department, meanwhile, supplies medication, including HIV treatments. Hlokomela also just registered as an NGO in the US, which Du Preez believes will make it easier to get US funding from philanthropic foundations based there. She says she's been working on the registration for 15 months. "One day we spoke with our managers, and I said we need to get money from America. We started with the application for an NGO in America called the Hlokomela Fund. I just got back from there to finalise it." Right now, though, there are rumours that the Trump administration may impose restrictions on money flowing from US-based philanthropic foundations to projects with sites in countries outside the US. Such restrictions could potentially influence how US-registered organisations are allowed to operate. Share the cost In 2016, Hlokomela decided to find new ways to help fund the health services they offered to farm workers. Before that, all health services were free because they were funded by grants and other donations. But grants and donations can end at any time, so having such services fully funded in this way means they can stop at any time. Some form of co-payment was needed, Hlokomela's managers argued: subsidised services are more sustainable than services which are 100% paid for by donors. First, Hlokomela had to work out how much clinic visits cost. Consultants brought on by Discovery helped calculate the average cost per clinic visit for patients, which came to R400. In 2021, Hlokomela introduced a three-tier co-payment system. Employers, like farmers and reserve owners, could subscribe for between R1 650 and R3 850 per month, based on their staff size. For example, those with up to 50 employees pay R1 650. If a worker went to the clinic for a consultation they only paid 30% of the consultation fee, the rest was covered by the employer's contribution. That system is still in place. Du Preez says some of the farmers weren't enthusiastic about the costs, but soon saw the benefits; if they had to take their workers to a government clinic, which was further away, long queues meant they'd have to wait at the clinic all day. But longtime, good relationships with the farmers helped. People from the area can also buy a monthly health card or pay for walk-in visits for R300. By the end of 2023, Hlokomela had around 16 employers with 2 000 employees subscribed and sold 554 health cards. This new revenue stream brought in around R2 million last year alone, according to Du Preez. Hlokomela also sells vegetables and dried fruits from their herb garden to retailers such as Pick n Pay and local lodges. As of February 2025, the partial-payment system made up around 11% of their budget, and the herb garden 2%. READ | The Global Fund will roll out the twice-yearly anti-HIV jab – with or without Pepfar Global Fund support for their sex worker programme — which also included money for HIV services — ended in April, but they've secured a six-month extension, albeit with half of the original budget. They'll have to make it stretch. Further funding from the Global Fund, which currently receives one-third of its funding from the US, could be under threat with the Trump administration's targeted slash-and-burn approach. Du Preez says that, just as they got through the Covid-19 pandemic without having to let any staff go, they plan to do the same in this crisis. "We've been doing it [outreach HIV testing] for the last 20 years and can't stop now ... There's always a plan B. Don't ask me what it is now, but we'll have one. We always try to have something else." Zano Kunene visited the Hlokomela clinic as part of a Discovery Foundation media tour in April. The Foundation covered the costs of the tour, but did not see or approve this story before publication. They also didn't have input on the content of this story.
Yahoo
28-02-2025
- Health
- Yahoo
US HIV funding cut is 'wake-up call' for S Africa
The US government's sudden decision to axe funding for HIV programmes is a "wake-up call" for South Africa, the country's health minister has told the BBC. Dr Aaron Motsoaledi, responding to US termination notices issued late on Wednesday, said the cuts could lead to deaths, but he had instructed state-funded clinics to ensure no patient went without life-saving drugs. There is chaos as many affected organisations scramble to find alternative help for some 900,000 HIV patients by the end of the day. "Instead of a careful handover, we're being pushed off a cliff," said Kate Rees from the Anova Health Institute, one of the biggest recipients of special US funding to counter the spread of HIV. The US's HIV programme was launched in 2003 by then US President George W Bush and is known as the US President's Emergency Plan for Aids Relief (Pepfar). Pepfar funding is distributed via the US government's main overseas aid agency USAID. It has been regarded as a ground-breaking scheme that has enabled some of the world's poorest people to access anti-retroviral drugs (ARVs) and has saved more than 25 million lives worldwide. A 90-day freeze on US foreign aid payments instituted by President Donald Trump on his first day in office last month has already upended the global aid system. What's really driving Trump's fury with South Africa? What is USAID and why is Trump poised to 'close it down'? South Africa is one of the biggest beneficiaries of Pepfar, which contributes about 17% to its HIV/Aids programme, in which about 5.5 million people out of eight million people living with HIV receive ARVs. Like all such US-funded organisations in South Africa, the Anova Health Institute was notified overnight on Wednesday about the decision by US President Donald Trump's administration to terminate tens of billions of dollars of aid contracts. Dr Rees described the announcement as one of the "worst days" of her career, especially as there had been plans afoot to reduce the dependency of HIV programmes on donor aid. This was to take place over the next five years, making it easier for the country's health department to take over, she said. Health experts say Pepfar funding was also helping with research for a cure for HIV, and that the cuts would set that work back years. The Desmond Tutu Health Foundation projects the US's move could result in as many as half a million deaths. South Africa's leading Aids lobby group, the Treatment Action Campaign (TAC), warned the country could see a return to when HIV patients struggled to access necessary services for their treatment. "We can't afford to die, we can't afford to go back to those years where we were suffering with access to services, especially for people living with HIV treatment," said TAC chair Sibongile Tshabalala. She was speaking during a digital news conference on Thursday, in which representatives from organisations that work with HIV patients described the chaos and despair caused by the termination of the funding. Ms Tshabalala, who has HIV, became emotional as she questioned how she and others like her would survive in the wake of the funding cuts. South Africa's ARV programme is the largest in the world. 'My wife fears sex, I fear death' - impacts of the USAID freeze Is it checkmate for South Africa after Trump threats? Why South Africa's health insurance is causing ructions Go to for more news from the African continent. Follow us on Twitter @BBCAfrica, on Facebook at BBC Africa or on Instagram at bbcafrica Africa Daily Focus on Africa
