Latest news with #aidCuts
News24
3 days ago
- Health
- News24
Graphs that paint the picture of HIV in SA: Part 3
Eight million people living with HIV. Just over 6 million on treatment. Behind these big numbers lurk a universe of fascinating epidemiological dynamics. In this special briefing, Spotlight editor Marcus Low unpacks what we know about the state of HIV in South Africa. This is part 3 of 3. In Part 1 of this Spotlight special briefing, we looked at some of the big picture dynamics of HIV in South Africa, and in Part 2, we considered some of the vulnerabilities of our HIV programme. Now, in Part 3, we zoom into some nuances relating to HIV prevention, the epidemic in different provinces, gender disparities, and HIV in kids – after which we conclude this special briefing with our take on where all this data suggests we should be focussing next in South Africa's HIV response. Prevention problems A landmark analysis published in 2022 found that the key reasons for the large decline in new infections in South Africa were antiretroviral treatment (since it makes people non-infectious) and the use of condoms. Voluntary medical male circumcision also contributed to reduced infections, more so for men, but also indirectly for women. To some extent, all of these interventions are threatened by the recent aid cuts. Even prior to the cuts there were concerns that both condom distribution and usage has declined. Incidentally, the provision of condoms is probably the area of HIV prevention that has been impacted least by the aid cuts. Last year, we reported extensively on injections that can provide HIV-negative people with six months of protection against HIV per shot. There are big unanswered questions about when these injections will become available and at what price, but experts have described it as a potential game-changer. In the meantime, daily antiretroviral tablets that prevent HIV infection have already been rolled out in the public healthcare system over the last five or so years. The numbers here are tricky to parse since many people start taking the pills and then stop. For example, while 501 000 women started taking the pills from mid-2023 to mid-2024, less than half that number were still taking the tablets in mid-2024 – keep this in mind when considering the above graph. Even so, there has clearly been a dramatic increase in women using HIV prevention pills in recent years. How provinces compare In South Africa, the health system, and most of the HIV programme for that matter, is run by provincial health departments. Apart from demographics differing massively between the country's nine provinces, the capabilities of their health departments also varies. It is thus no surprise that the HIV numbers look very different in different provinces. Part of the difference between provinces is determined by things health departments can do little about, for instance the Eastern Cape quite simply is a more rural province than Gauteng. On the other hand, some provincial departments have been chronically dysfunctional for decades which has no doubt impacted their HIV numbers. Gauteng and KwaZulu-Natal (KZN) are comfortably the country's largest provinces by population, and it is thus no surprise that together they account for over 60% of all the country's HIV cases. But apart from their absolute numbers, they also have particularly high HIV prevalence – roughly 16% of people in KZN are living with HIV, compared to 7% in the Western Cape. In terms of treatment coverage, the three worst performing provinces are the Eastern Cape, Gauteng, and Limpopo – all at around 73%. At 74%, the Western Cape is not much better. KZN leads the pack with 84%. We focus on treatment coverage here since we consider it the single number that tells us most about how well a province is doing. Maybe the most important contrast here is that between KZN and Gauteng. Both provinces have just under two million people living with HIV. Conventional wisdom would have it that delivering treatment would be harder in a more rural province like KZN, yet treatment coverage in KZN is more than ten percentage points higher than it is in Gauteng. It is worth noting though that estimated HIV-related deaths are nevertheless higher in KZN than in Gauteng – possible explanations include much higher TB rates in KZN and worse socio-economic conditions. Differences between men and women One of the most striking aspects about HIV in South Africa is that almost double as many women as men are living with the virus – 5.2 million versus 2.6 million in 2024. The reasons for this are not entirely clear but it is likely due to a combination of biology and social factors that determine who has sex with who. Given these numbers, one might expect that many more women would be dying of HIV-related causes than men, but that is not what is happening. In fact, in 2023/2024, 27 100 men died of HIV-related causes compared to 24 200 women. Men are thus less likely to contract HIV than women, but once they have the virus in their bodies, they are on average much more likely to die of it than women. The numbers suggest that this is at least in part because men are both less likely than women to get tested for HIV and to take treatment once diagnosed. The kids are not quite all right It may come as a surprise to some that, even in the mid-2020s, we still have around 7 000 new HIV-positive babies every year in South Africa. Things have improved massively since two decades ago when the number was more than 10 times higher, but it is worrying that we haven't been able to get it closer to zero. In fact, progress has slowed in recent years. The dynamics here are not obvious. Most pregnant women in South Africa attend antenatal visits where they are routinely offered HIV testing. If the mother tests positive, she is immediately put on antiretroviral treatment that can suppress the virus and protect both her and the baby. Because of such HIV testing in the antenatal period, we have seen dramatically fewer vertical (mother-to-child) transmissions at or during birth. Instead, an increasing proportion of vertical transmissions happen in cases where the mother only contracts HIV in the months after birth and then transmits the virus to her baby during breastfeeding, all before she herself has been diagnosed. Since a person's HIV viral load spikes very high in the first weeks after infection, this can happen very quickly. Apart from ongoing vertical transmissions, another point of concern is the estimate that one in three children living with HIV are not taking antiretroviral treatment. (We have unpacked the dynamics behind this in a previous article.) What is to be done? In a study conducted in KwaZulu-Natal a few years ago, researchers found that people with HIV who only visited the clinic once a year did as well as people who visited the clinic every six months. The nurses at the facilities involved were however convinced that the 12-month group would be worse off – if it was up to them everyone would have to come every six months. Well-intentioned as these nurses were, doing it their way would mean more work for them and more clinic visits and more waiting in line for their clients. Of course, for those people who are ill or struggling, there must be the option of much more regular visits. But for those who are stable on treatment and doing well, we should at most be asking them to visit the clinic once a year and pick up medicines somewhere convenient every six months. ALSO READ | Are children living with HIV being left behind? What the stats tell us South Africa has made tremendous progress against HIV. Yet, as we have shown in this Spotlight special briefing, there are gaps, most notably the fact that one in five people living with the virus are not on treatment. Getting that fifth person on to treatment, might require us doing things differently than before. Quite simply, we need to make it easier and more convenient for people to start and stay on treatment. We have already made several of the right moves. Condom distribution has mostly been a success, it is easy to get an HIV test, allowing nurses to get people started on treatment without the involvement of doctors has worked well, and giving people the option of collecting their ARVs at pick-up points such as private pharmacies has made many people's lives easier. ALSO READ | Francois Venter: Our HIV programme is collapsing and government is nowhere to be seen Though it's come a long way, the medicines distribution system still falls short of providing everyone with a convenient option for collecting their medicines near their home or workplace. Too often people still get only enough tablets for a month or two at a time. For those not keen on visiting clinics, getting an ARV prescription straight from a pharmacy is unfortunately not yet an option. Many people still feel disrespected by the health system meant to support them. Over the last two decades, we have rightfully been somewhat fixated with numbers like treatment coverage. One might argue that to scale up treatment as quickly as we did, we couldn't afford for care to be as personalised as we'd like. But with the world's largest treatment programme in place and a mature epidemic, the context has changed. It is clear where the remaining gaps are – closing those gaps will require that government gets serious about making the health system much, much more friendly to those it is meant to support. *You can find the complete version of this #InTheSpotlight special briefing as a single page on the Spotlight website. Note: All of the above graphs are based on outputs from version 4.8 of the Thembisa model published in March 2025. We thank the Thembisa team for sharing their outputs so freely. Graphs were produced by Spotlight using the R package ggplot2. You are free to reuse and republish the graphs. For ease of use, you can download them as a Microsoft PowerPoint slide deck. Technical note: The Thembisa model outputs include both stock and flow variables. This is why we have at some places written 2024 (for stock variables) and 2023/2024 (for flow variables). 2024 should be read as mid-2024. 2023/2024 should be read as the period from mid-2023 to mid-2024. Reviewed by Dr Leigh Johnson. Spotlight takes sole responsibility for any errors. Show Comments ()
Bloomberg
28-05-2025
- Business
- Bloomberg
Meet the Five People Vying to Lead the African Development Bank
The African Development Bank, the continent's largest home-grown multilateral lender, will elect its new leader on Thursday. Five candidates are vying for the job as the institution confronts multiple challenges, including aid cuts to Africa, the withdrawal of support by US President Donald Trump and the fallout from his trade war.
The Independent
22-05-2025
- Politics
- The Independent
More than 60 charities demand UK reverse ‘shameful' aid cuts that will expose women and girls to abuse
More than 60 major UK and international charities have called for the government to reverse funding cuts that they warn will ensure the 'worst aid budget for women and girls on record'. In a joint statement signed by Oxfam, Save the Children, World Vision and Care International, the 61 charities say they are 'deeply alarmed' by the 'shameful proposal' to shift money away from projects that specifically support women and girls by scrapping dedicated spending on gender equality. The charities estimate the closure of just one UK-funded violence prevention project, the 'What Works' programme, would put more than one million women and children at increased risk of abuse worldwide. One charity chief executive called the cuts 'dangerous'. In February, prime minister Sir Keir Starmer announced a plan to cut aid spending from 0.5 per cent to 0.3 per cent of the UK's gross national income (GNI) – a measure of the nation's total wealth. That amounts to roughly £6 billion cut from a current budget of £15.4bn. On 14 May, development minister Jennifer Chapman told MPs these cuts would fall on gender and education programmes, as the government sought to 'sharpen [its] focus' on humanitarian emergencies in Gaza, Ukraine and Sudan. However, the coalition of leading charities have warned these cuts will mean 'specialised services for survivors of rape will disappear, girls will miss out on education, and women will continue to be excluded from positions of power and influence'. Currently just 12 per cent of all UK aid currently prioritises gender equality, which the charities say must be protected – with more than half of women's rights organisations surveyed by the coalition in developing countries saying they will have to close in the next six months because of aid cuts. 'We urge the UK Government to reverse course. It otherwise risks sending the message that the rights and lives of women and girls are expendable,' the statement reads. 'Without investment that specifically supports women and girls, specialised services for survivors of rape will disappear, girls will miss out on education, and women will continue to be excluded from positions of power and influence,' the statement adds. 'These decisions aren't simply about numbers on a balance sheet – they are choices that determine whether women and girls live in safety, go to school, or access healthcare. Behind every cut is a person whose life and future are at stake. 'As a coalition of organisations working toward a gender-just world both in the UK and overseas, we are deeply alarmed by the shameful proposal to eradicate standalone aid funding for gender equality.' Beyond gender equality spending, the 40 per cent cut to the UK's spending in developing countries is projected to leave millions at risk of malnutrition. An analysis by Save the Children previously shared with The Independent found the 'savage' cuts to UK foreign aid would leave 55.5 million of the world's poorest people without access to basic resources. Addressing the international development select committee last week, Baroness Chapman said: 'There will be a huge impact, I'm not pretending otherwise. I can't promise to protect every good programme'. She claimed that the crises in Ukraine, Gaza and Sudan are 'actually where the public expects us to lead'. But in their statement, the coalition of charities cited polling by YouGov that showed that 63 per cent of respondents think the aid budget should be used to protect women's and girls' rights. The UK's aid cuts come at a time when many rich countries are shifting spending away from development. But none has cut as deeply as the US, where Donald Trump 's decision to slash overseas spending is already having wide-ranging destructive effects, from leaving millions on the brink of famine, to derailing the end of the AIDS pandemic, driving millions of preventable deaths. Dr Halima Begum, chief executive of Oxfam GB said: 'The UK government's proposed rollback on dedicated funding for gender equality is beyond concerning – it's dangerous. With the rise of anti-rights movements, the fight to protect the rights of women and girls is more important than ever. 'Not only does it threaten the gains that have been made in recent decades, she said, but it is 'simply wrong that the Government is choosing to push more people into poverty and deepen gender inequality while the surging wealth of the super-rich goes untouched.'
The Guardian
15-05-2025
- Politics
- The Guardian
Britain's aid cuts will be catastrophic for women and girls
This government is on course to go down in history as one of the worst for women and girls (Labour to defend aid cuts, claiming UK's days as 'a global charity' are over, 13 May). We already know that the aid cuts will be deadly, but wiping out all funding to programmes that support women and girls is a new low – even if the government is saying the budget for women and girls will be 'mainstreamed' or folded into other programmes. Specific programmes help girls into education, help mothers deliver babies safely, and protect women from violence. While some governments are stepping back from supporting women, I never imagined the UK would follow suit. It's not only catastrophic in the short term for women who will have life-saving support withdrawn but a shortsighted measure that will ultimately work against the government's own peace, security and growth agenda. Evidence shows that when women thrive, communities and economies prosper, and societies become more peaceful. It's in everyone's interest to ensure that this rash decision, made to balance the books, doesn't now cause irreparable harm in the long run. The government's rhetoric about 'global charity' and its decision to make savings on the backs of women and girls marks a dangerous shift away from the British values of inclusion and solidarity that it claims to celebrate. This plan would not only be another broken manifesto pledge but it signifies the UK joining a tragic race to the bottom. Dr Helen PankhurstSenior adviser on gender equality, Care International UK I have decided to follow the example of our esteemed development minister and cancel all my charitable giving in exchange for offering my special expertise. If all UK donors follow the same example, we can destroy the charitable sector and present our esteemed chancellor and her disgraceful colleagues with a massive problem. That is what is now happening in the developing world. First, Donald Trump decided to cancel USAID, and then his proxy in the UK cabinet decided to kiss his bottom and reduce UK spending in exchange for any expertise that we may have (not much!). For the avoidance of doubt, I was opposed to reducing the foreign aid budget from 0.5% to 0.3% of GDP from 2027. As a higher-rate taxpayer, I believe that I can plead a case for how tax revenues are spent. What a shower!Trevor BonnerSolihull, West Midlands Have an opinion on anything you've read in the Guardian today? Please email us your letter and it will be considered for publication in our letters section.
Telegraph
15-05-2025
- Health
- Telegraph
HIV testing and monitoring down by a fifth after Trump aid cuts
Crucial testing and monitoring of vulnerable South African HIV patients has fallen by up to a fifth since Donald Trump cut aid to health workers and clinics, government data shows. The testing to monitor blood virus levels has fallen by 17 per cent in young people, and by 21 per cent in pregnant women. The data reported by Reuters also shows that testing in infants has fallen by a fifth and is one of the most concrete signs yet of the effect the aid cuts are having on the country with the highest number infected by HIV. Aaron Motsoaledi, health minister, admitted the funding cuts had caused problems, but strongly denied suggestions the country's anti-HIV campaign was close to collapse. He said: 'Under no circumstances will we allow this massive work conducted over more than a decade and a half to collapse and go up in smoke because of what President Trump has done.' Modelling released in March has already predicted the cuts could trigger soaring rates of global HIV infections and millions of deaths. There could be between 4.4m to 10.8m additional new HIV infections by the end of this decade in low-and-middle income countries according to the forecasts published in the Lancet journal. Regular testing of HIV patients is considered vital for managing the long-running outbreak because it tells whether treatment is keeping the virus in check, and whether it is sufficiently suppressed to prevent it spreading to others. Testing is particularly important in pregnant women who are at risk of passing on the infection during childbirth. Public health experts warn that with less testing, fewer people who are at risk of transmitting the virus will be identified. Missing a test can also indicate that a patient has dropped out of the system and may be missing treatment. Trump froze many foreign aid programmes by executive order in the early days of his administration. South Africa was doubly hit, as he also targeted aid to the country for allegedly discriminating against white people. He falsely said white land was being seized by the government. South Africa did not rely on America for its anti-HIV drugs but did rely on the United States President's Emergency Plan for Aids Relief (PEPFAR) to pay 15,000 health workers. These workers did HIV testing and counselling in hotspots and checked up on patients who had dropped off their medication. 'These are shocking figures, with profound implications for maternal and child health across the country,' said Francois Venter, executive director of the Ezintsha Research Centre in Johannesburg.
