South Africa is scrambling to keep its world-leading HIV programme alive after the US yanked more than $427m in funding – a cut that has already shuttered clinics, driven patients to the black market, and left thousands fearing for their lives.
The country carries the heaviest HIV burden in the world, with around 8 million people living with the virus. Yet even before the cuts, just a quarter were receiving treatment. Now, experts warn the crisis could unravel years of hard-won progress, sparking fresh waves of infection and preventable deaths.
“We are scared,” says activist Yvette Raphael, co-founder of Advocacy for Prevention of HIV and AIDS. “We are scared of seeing people dying again, of infants born with HIV, of everything we fought for slipping away. The money America gave us was plugging holes our own government couldn’t fix.”
The withdrawal – part of former US President Donald Trump’s foreign aid squeeze – has hit the most vulnerable hardest. More than 60,000 people lost access when 12 dedicated clinics shut down, while up to 220,000 have faced interruptions to vital daily medication. Patients report being turned away from hospitals, and some have resorted to buying overpriced drugs from street dealers.
For many, the cuts feel like a death sentence. A Johannesburg sex worker described how community clinics once tested her every three months, delivered refills to her flat, and supplied condoms and lubricant. “Now, nothing,” she said. “Our lives matter. We are human.”
Washington has defended its decision, with budget officials insisting US taxpayers cannot carry Africa’s health bill indefinitely. A partial waiver has allowed some services to resume, but campaigners say the disruption has already done irreparable harm.
Across South Africa, the fear is palpable: that without urgent solutions, the world’s largest HIV programme could collapse – and with it, the fragile lifeline of millions.
