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Daily Maverick
21-05-2025
- Health
- Daily Maverick
Open letter to Health Minister Aaron Motsoaledi: Please explain the HIV numbers
Minister of Health Dr Aaron Motsoaledi's recent claim that more than half a million people have been newly started on HIV treatment in less than six months has raised eyebrows in health circles. In this open letter, Anna Grimsrud and Sibongile Tshabalala-Madhlala, associated with Change – South Africa, ask the minister to explain numbers that, on the face of it, seem contradictory. Dear Minister Motsoaledi, We write to you in response to your 15 May 2025 press statement and subsequent remarks in Parliament on the current status of the national HIV, Aids, and TB campaign. You stated that since the launch of the Close the Gap campaign, 520,700 people have been initiated on HIV treatment, reaching 'more than 50% of the target'. You also stated that 5.9 million people were currently on antiretroviral therapy (ART). However, at the campaign's launch on 25 February 2025, you reported the same number on HIV treatment — 5.9 million. This raises a critical question: If more than half a million people have started or restarted treatment, why has the total number of people on treatment not increased? If both figures are accurate, this would mean that approximately 520,000 people have been lost from care over the past few months — a deeply concerning and unprecedented level of attrition. We respectfully request that you provide the underlying data and clarify the current total number of people remaining on HIV treatment. There are several reasons why we are concerned: Static treatment numbers: As noted, the number on treatment was reported as 5.9 million in both February and May 2025. If 520,700 people have been initiated or re-initiated during this period, the same number must have exited care — a scenario that requires urgent explanation. Slow growth in the number of people on treatment: According to official statements, the total number of people on HIV treatment increased by only 100,000 between March and December 2023 — from over 5.7 million to 5.8 million. The claim that the cohort has now grown by more than 500,000 in a matter of months contradicts recent trends. Declining lab numbers: National Health Laboratory Service data reported by the Daily Maverick and Reuters, show notable declines in viral load testing and early infant diagnosis in March and April 2025 compared with the same months in 2024. These indicators should increase alongside meaningful growth in treatment uptake — not decrease. In light of these concerns, we believe it is essential that you provide a transparent accounting of the current number of people on treatment and the metrics being used to assess progress under the Close the Gap campaign. Specifically, we request data demonstrating that the programme is on track to meet its stated goal: increasing the number of people on treatment from 5.9 million to 7 million. We share your commitment to a strong and effective HIV response, especially in this period of financial and operational strain. Like you, we believe it is vital that accurate and complete information is shared with the public and Parliament at this critical moment. DM Anna Grimsrud is an epidemiologist with a PhD in Public Health and writes in her personal capacity. Sibongile Tshabalala-Madhlala is openly living with HIV and currently serves as the National Chairperson of the Treatment Action Campaign (TAC). Change is a coalition of more than 1 500 people from civil society organisations in South Africa and around the world — people living with HIV, activists, community health workers, researchers, programme members, epidemiologists, clinicians, economists, and others. Change stands for Community Health & HIV Advocate Navigating Global Emergencies.
IOL News
16-05-2025
- Health
- IOL News
Health Minister Aaron Motsoaledi addresses HIV testing decline following funding cuts
Health Minister Aaron Motsoaledi says the country's HIV/ Aids programme is not collapsing despite decline in HIV testing. Image: Bongani Shilubane / Independent Newspapers Minister of Health Aaron Motsoaledi stated that while there may be a decline in HIV testing following the funding cuts by the United States' President's Emergency Plan for AIDS Relief (Pepfar), the country's HIV/Aids programme is not collapsing. This comes after Reuters reported this week that data from an unpublished document by the National Health Laboratory Service, a government entity, seen by the agency, showed that viral load testing declined by up to 21% among key groups in the last two months. For individuals with HIV undergoing anti-retroviral therapy, viral load testing quantifies the amount of virus present in their bloodstream. Viral load testing for individuals aged 15-24 declined by 17.2% in April compared to last April, after dropping 7.8% year-on-year in March. Overall population testing decreased 11.4% in April, according to Reuters. Maternal viral load testing was down 21.3% in April, after declining by 9.1% in March. Early infant diagnostic testing was also down 19.9% in April after declining by 12.4% in March. Additionally, nationwide, viral suppression rates among tested individuals decreased by 3.4% in March and 0.2% in April. Young adults experienced even greater declines, suggesting potential disruptions in patient treatment, the data showed. During a briefing on the status of the HIV/Aids and TB Campaign in South Africa, the Minister said that he has never stated that everything is fine in the country following the funding withdrawal. 'I never said everything is fine. All I said is that it's wrong to say the campaign of the HIV/Aids programme in South Africa is collapsing because it's not… If viral load testing has dropped, does it mean the collapse of the campaign by any stretch of imagination? No, we expected that some of these problems will occur, but we are sitting with them every day,' he said. According to reports, the Centre for the AIDS Programme of Research in South Africa (Caprisa) community programmes head and Treatment Action Campaign (TAC) deputy general secretary, Patrick Mdletshe, stated that the decline in viral load testing in South Africa can be attributed to funding cuts, particularly from Pepfar. 'These cuts have significantly impacted HIV testing and treatment programmes, especially among vulnerable populations such as pregnant women, infants, and young adults,' he said. Video Player is loading. Play Video Play Unmute Current Time 0:00 / Duration -:- Loaded : 0% Stream Type LIVE Seek to live, currently behind live LIVE Remaining Time - 0:00 This is a modal window. Beginning of dialog window. Escape will cancel and close the window. 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Text Color White Black Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Background Color Black White Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Transparent Window Color Black White Red Green Blue Yellow Magenta Cyan Transparency Transparent Semi-Transparent Opaque Font Size 50% 75% 100% 125% 150% 175% 200% 300% 400% Text Edge Style None Raised Depressed Uniform Dropshadow Font Family Proportional Sans-Serif Monospace Sans-Serif Proportional Serif Monospace Serif Casual Script Small Caps Reset restore all settings to the default values Done Close Modal Dialog End of dialog window. Next Stay Close ✕ Mdletshe said that some of the key factors contributing to the decline are reduced funding and closure of NGO-run clinics primarily funded by Pepfar, which will consequently increase the risk of HIV transmission and lead to the disruption of treatment. Professor Wolfgang Preiser, who heads the Medical Virology Department of Pathology at Stellenbosch University and the NHLS at Tygerberg Hospital, said that while they have seen a decline of test volumes for those markers recently, this decline cannot be attributed to the Pepfar cuts as there are other, parallel issues that also affect how many samples are received for testing. He said some of these parallel factors are based on internal rearrangements within the NHLS between its different laboratories. 'When looking at NHLS test figures from year to year, you should factor in the network downtime last year following the cyberattack. That is long resolved but it is reflected in test volumes still,' added Preiser. Kate Rees, public health specialist from the Anova Health Institute, said the organisation's programmes have been terminated. 'We cannot say to what extent there is a decline in the indicators. I have seen NHLS and Department of Health data that shows a decline in viral load testing nationally and HIV testing in Johannesburg. But it is not my data.' Networking HIV and AIDS Community of Southern Africa (Nacosa) spokesperson, Sophie Hobbs, said their Pepfar-funded programme that monitored viral loads of children and adolescents in the city of Cape Town has also been terminated. Hobbs said Nacosa has, as a result, not been able to collect this data. She stated that according to the latest Thembisa Model estimates, there are significant gaps for children and youth in the Western Cape, with only a 67% antiretroviral therapy coverage rate and a 73% viral suppression rate in children under 15. 'Before it was terminated, our programme in Cape Town had very good treatment adherence (100%) and viral suppression rates,' said Hobbs. The Minister further explained that of the R46.8 billion South Africa spends on the HIV/Aids programme, only R7.9bn was from Pepfar. 'It is inconceivable that out of R46.8bn spent by the country on the HIV programme, the withdrawal of R7.9bn by President Donald Trump will collapse the entire programme,' he said. The Minister said since the Pepfar funding was pulled, in the 27 high-HIV burden Pepfar-supported districts, out of 57 across the country, there are 2,772 public health facilities. He said in these 27 districts, there were only 12 specialised clinics independent from the government, managed by the NGOs providing services mainly for key populations funded by Pepfar. Key populations include transgender individuals, men who have sex with men, sex workers, and people who inject drugs. 'In these 27 districts, the total number of these key population clients served by these 12 specialised clinics was 63,322, of which 41,996 are found in the City of Johannesburg,' he said. Motsoaledi said when the Pepfar-funded clinics were closed, the Department removed their files from those clinics to the nearest public facilities. 'We can confirm that all 63,322 have been moved. Then the work to contact their owners to transfer them to public health facilities where their files are started in earnest and still continues,' he said. The Minister highlighted that there are other prominent funders like the Global Fund that have been supporting the country with health services for key populations. '34 designated facilities are funded by the Global Fund for this purpose across Gauteng, Free State, North West, Limpopo, Eastern Cape, KZN, Mpumalanga, and Western Cape.'
IOL News
16-05-2025
- Health
- IOL News
SA won't beg USA for funding
Health Minister Dr Aaron has assured South Africans that the country's HIV/Aids funding has not collapsed. Image: Oupa Mokoena / Independent Newspapers SOUTH Africa will not beg the Trump administration to reinstate the US-backed programme that directly supported more than 16 000 health workers and played a key role in this country's fight against HIV/AIDS, says Health Minister Dr Aaron Motsoaledi. Motsoaledi assured South Africans that the country's HIV/Aids programme was not at risk of collapsing due to the withdrawal of US foreign aid funding through the US President's Emergency Plan for Aids Relief (Pepfar). His remarks came a day after Reuters reported that funding cuts, particularly from the US, have been cited as the reason behind South Africa's startling decline in viral load testing. "At the present moment, all we can do is present our plans to funders. I have given you a long list of funders we have met. There is not a single one who said, 'No, we will not help'. But up until today, there is not a single one who has come to the party. Either private funders or government around – there is not a single one," he said. The Reuters report cited recent figures from the National Health Laboratory Service indicating a concerning decline in viral load testing - a crucial measure that determines the amount of HIV virus present in the bloodstream of patients undergoing antiretroviral treatment. Experts report a staggering 21% drop in testing rates among key demographics over the past two months, directly linking these reductions to the loss of US funding. Viral load testing, according to experts, is essential for monitoring treatment effectiveness and suppressing the virus to lower transmission risks. Pregnant women, in particular, face increased risks of transmitting HIV during childbirth, while infants need timely diagnoses for their survivability in the face of this virus. Video Player is loading. Play Video Play Unmute Current Time 0:00 / Duration -:- Loaded : 0% Stream Type LIVE Seek to live, currently behind live LIVE Remaining Time - 0:00 This is a modal window. Beginning of dialog window. Escape will cancel and close the window. Text Color White Black Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Background Color Black White Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Transparent Window Color Black White Red Green Blue Yellow Magenta Cyan Transparency Transparent Semi-Transparent Opaque Font Size 50% 75% 100% 125% 150% 175% 200% 300% 400% Text Edge Style None Raised Depressed Uniform Dropshadow Font Family Proportional Sans-Serif Monospace Sans-Serif Proportional Serif Monospace Serif Casual Script Small Caps Reset restore all settings to the default values Done Close Modal Dialog End of dialog window. Advertisement Next Stay Close ✕ Ad Loading Viral load tests among people aged 15-24 reportedly fell by 17.2% in April compared to the same month the previous year, compounding a steady decline observed in March. Overall, testing across the population decreased by 11.4%, while the number of maternal tests sunk by 21.3%, raising alarms about the future health of mothers and children throughout the country. However, Motsoaledi said: 'It is inconceivable that out of R46.8 billion spent by the country on the HIV/AIDS programme, the withdrawal of R7.9 billion by (United States) President Trump will immediately lead to a collapse of the entire programme. We believe this is inconceivable. Ladies and gentlemen, we want to put this categorically clear that under no circumstances will we allow this massive work performed over a period of over a decade and a half to collapse and go up in smoke because President Trump has decided to do what he has done." Claire Waterhouse, head of Operational Support Unit at Doctors Without Borders, Southern Africa said the organisation was 'very concerned' by the latest data from the NHLS showing significant drops in HIV testing and monitoring in South Africa. 'Viral load testing is critical for keeping a finger on the pulse of the success of South Africa's HIV response, especially in vulnerable populations like pregnant and breastfeeding women, sex workers and LGBTQI communities. "Early this year, MSF flagged its extreme worry about the potential impact of US funding cuts on HIV and TB responses in South Africa and globally, due to the far-reaching support previously provided by PEPFAR and USAID to governments, organisations and communities. "It would be a realisation of some of our worst fears if what this latest data shows can be attributed to funding cuts. If this is indeed the case, we continue to urge governments, in this case the South African government in particular, and other potential donor countries and organisations to step up and urgently take measures to prevent the reversal of decades of progress in the fight against HIV.' Treatment Action Campaign co-founder and anti-Aids activist Zackie Achmat disrupted the proceedings of a scheduled meeting of the Portfolio Committee on Health this week to highlight concerns regarding service delivery disruptions stemming from the withdrawal of PEPFAR funds. In a statement on Thursday, committee chairperson Dr Sibongiseni Dhlomo said MPs acknowledged the gravity of the concerns Achmat raised. The committee intends to meet with him in the coming weeks. 'Committee members emphasised their understanding that such funding cuts can lead to gaps in service delivery, adversely affecting vulnerable populations who rely on these services for their health and well-being…Before the planned meeting with Mr Achmat, the committee will engage with the Minister of Health, Dr Aaron Motsoaledi, on Friday, 16 May, to receive an update on the PEPFAR withdrawal. This engagement will allow the committee to gather relevant information and insights, ensuring that they have answers to the matters raised by Mr Achmat ready for their subsequent meeting. This engagement would help ensure that the committee is well-informed about the realities facing communities on the ground.' Cape Times
Russia Today
15-05-2025
- Health
- Russia Today
Funding cuts threaten HIV response efforts in South Africa
Funding cuts, particularly from the United States' President's Emergency Plan for AIDS Relief (Pepfar), have been cited as a reason behind South Africa's startling decline in viral load testing. Earlier this year, President Donald Trump withdrew funding from the Pepfar. This meant suspending some of the United States' funding for HIV and TB programmes in African countries for 90 days. During his State of the Nation Address, President Cyril Ramaphosa said the US funding represents about 17% of South Africa's HIV spend. Reuters on Wednesday reported that data from the National Health Laboratory Service, a government entity, showed that viral load testing declined by up to 21% among key groups in the last two months. For individuals with HIV undergoing anti-retroviral therapy, viral load testing quantifies the amount of virus present in their bloodstream. Viral load testing for individuals aged 15-24 declined by 17.2% in April compared to last April, after dropping 7.8% year-on-year in March. Overall population testing decreased 11.4% in April, according to Reuters. Maternal viral load testing was down 21.3% in April, after declining by 9.1% in March. Early infant diagnostic testing was also down 19.9% in April after declining by 12.4% in March. Additionally, nationwide, viral suppression rates among tested individuals decreased by 3.4% in March and 0.2% in April. Young adults experienced even greater declines, suggesting potential disruptions in patient treatment, the data showed. This is from unpublished data the news agency has seen. Centre for the AIDS Programme of Research in South Africa (Caprisa) community programmes head and Treatment Action Campaign (TAC) deputy general secretary Patrick Mdletshe said: 'The decline in viral load testing in South Africa can be attributed to funding cuts, particularly from the United States' President's Emergency Plan for AIDS Relief (Pepfar). 'These cuts have significantly impacted HIV testing and treatment programs, especially among vulnerable populations such as pregnant women, infants, and young adults.' Mdletshe said key factors contributing to the decline are: He said the expected consequences include: Responding to Reuters, Department of Health spokesperson Foster Mohale said additional analysis was necessary, as South Africa was already facing difficulties with patient retention and viral load testing before the reduction in aid. However, he said the government was speaking to prospective local and international donors about covering funding gaps. According to a World Health Organisation (WHO) policy brief, evidence suggests that if a mother living with HIV is taking antiretroviral therapy and maintains a suppressed viral load during pregnancy, delivery and breastfeeding, the risk of vertical HIV transmission can be as low as <1%. If a mother is taking antiretroviral therapy and is undetectable before and throughout pregnancy and delivery, there is no risk of transmitting to the infant during pregnancy. Additionally, people living with HIV who have an undetectable viral load have zero risk of transmitting HIV sexually, and those with a suppressed viral load have almost zero risk of transmitting HIV to a sexual published by IOL
IOL News
15-05-2025
- Health
- IOL News
Funding cuts 'threaten HIV testing in South Africa'
Funding cuts from the United States' Pepfar programme have led to a significant decline in HIV viral load testing in South Africa. Image: Reuters Funding cuts, particularly from the United States' President's Emergency Plan for AIDS Relief (Pepfar), have been cited as a reason behind South Africa's startling decline in viral load testing. Earlier this year, President Donald Trump withdrew funding from the Pepfar. This meant suspending some of the United States' funding for HIV and TB programmes in African countries for 90 days. During his State of the Nation Address, President Cyril Ramaphosa said the US funding represents about 17% of South Africa's HIV spend. Reuters on Wednesday reported that data from the National Health Laboratory Service, a government entity, showed that viral load testing declined by up to 21% among key groups in the last two months. For individuals with HIV undergoing anti-retroviral therapy, viral load testing quantifies the amount of virus present in their bloodstream. Video Player is loading. Play Video Play Unmute Current Time 0:00 / Duration -:- Loaded : 0% Stream Type LIVE Seek to live, currently behind live LIVE Remaining Time - 0:00 This is a modal window. Beginning of dialog window. Escape will cancel and close the window. Text Color White Black Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Background Color Black White Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Transparent Window Color Black White Red Green Blue Yellow Magenta Cyan Transparency Transparent Semi-Transparent Opaque Font Size 50% 75% 100% 125% 150% 175% 200% 300% 400% Text Edge Style None Raised Depressed Uniform Dropshadow Font Family Proportional Sans-Serif Monospace Sans-Serif Proportional Serif Monospace Serif Casual Script Small Caps Reset restore all settings to the default values Done Close Modal Dialog End of dialog window. Advertisement Video Player is loading. Play Video Play Unmute Current Time 0:00 / Duration -:- Loaded : 0% Stream Type LIVE Seek to live, currently behind live LIVE Remaining Time - 0:00 This is a modal window. Beginning of dialog window. Escape will cancel and close the window. Text Color White Black Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Background Color Black White Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Transparent Window Color Black White Red Green Blue Yellow Magenta Cyan Transparency Transparent Semi-Transparent Opaque Font Size 50% 75% 100% 125% 150% 175% 200% 300% 400% Text Edge Style None Raised Depressed Uniform Dropshadow Font Family Proportional Sans-Serif Monospace Sans-Serif Proportional Serif Monospace Serif Casual Script Small Caps Reset restore all settings to the default values Done Close Modal Dialog End of dialog window. Next Stay Close ✕ Viral load testing for individuals aged 15-24 declined by 17.2% in April compared to last April, after dropping 7.8% year-on-year in March. Overall population testing decreased 11.4% in April, according to Reuters. Maternal viral load testing was down 21.3% in April, after declining by 9.1% in March. Early infant diagnostic testing was also down 19.9% in April after declining by 12.4% in March. Additionally, nationwide, viral suppression rates among tested individuals decreased by 3.4% in March and 0.2% in April. Young adults experienced even greater declines, suggesting potential disruptions in patient treatment, the data showed. This is from unpublished data the news agency has seen. Centre for the AIDS Programme of Research in South Africa (Caprisa) community programmes head and Treatment Action Campaign (TAC) deputy general secretary Patrick Mdletshe said: 'The decline in viral load testing in South Africa can be attributed to funding cuts, particularly from the United States' President's Emergency Plan for AIDS Relief (Pepfar). 'These cuts have significantly impacted HIV testing and treatment programs, especially among vulnerable populations such as pregnant women, infants, and young adults.' Mdletshe said key factors contributing to the decline are: Reduced funding: Pepfar funding cuts have led to a decrease in health worker budgets, resulting in reduced access to care and testing services. Closure of clinics: NGO-run clinics, which were primarily funded by Pepfar, have been shut down, further limiting access to testing and treatment. Impact on vulnerable populations: The decline in viral load testing has been particularly significant among key groups. He said the expected consequences include: Increased risk of transmission: The decline in viral load testing and suppression may lead to an increased risk of HIV transmission, particularly among vulnerable populations. Disruption of treatment: Patients may have had their treatment interrupted, which can lead to treatment failure and the development of drug-resistant strains of HIV. Responding to Reuters, Department of Health spokesperson Foster Mohale said additional analysis was necessary, as South Africa was already facing difficulties with patient retention and viral load testing before the reduction in aid. However, he said the government was speaking to prospective local and international donors about covering funding gaps. According to a World Health Organisation (WHO) policy brief, evidence suggests that if a mother living with HIV is taking antiretroviral therapy and maintains a suppressed viral load during pregnancy, delivery and breastfeeding, the risk of vertical HIV transmission can be as low as <1%. If a mother is taking antiretroviral therapy and is undetectable before and throughout pregnancy and delivery, there is no risk of transmitting to the infant during pregnancy. Additionally, people living with HIV who have an undetectable viral load have zero risk of transmitting HIV sexually, and those with a suppressed viral load have almost zero risk of transmitting HIV to a sexual partner.
