US Funding Freeze: South Africa's HIV and Health Programmes in Jeopardy

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The US foreign aid funding freeze is not just about dollars and “handouts” — it is about lives, human rights and South Africa’s enduring role in shaping a more just and effective health system. The termination of US funding for HIV and health programmes has destabilised critical initiatives and programmes across the Global South. In South Africa, it has triggered a health crisis, jeopardising access to essential medicines and services, as well as the broader public health infrastructure. While some see this as an opportunity for “self-reliance,” rising anti-American sentiment risks diluting focus on the immediate crisis.

Oversimplifying this emergency into binaries of local self-reliance versus global support, HIV-specific care versus broader public health, and US President Donald Trump’s realpolitik versus humanitarian imperatives, also diverts attention from the reality that interdependence, not isolation, is crucial for sustaining life-saving health responses. US funding supported specialised programmes for key populations in South Africa, providing safe spaces, social support and human rights advocacy for vulnerable groups. This includes sex workers, migrants, people who use drugs and LGBTQ+ individuals. Due to widespread stigma, legal barriers and other social factors, these groups face a significantly higher risk of HIV and of being denied affordable, respectful and non-stigmatising healthcare within the public system.

Research has extensively documented how some experience unfriendly facility staff, confidentiality violations and denial of services and medication in the public health system. As a result, they often depend on carefully tailored programmes to address their specific needs and the barriers they encounter. The abrupt termination of funding has severely disrupted and in some cases halted these programmes, creating uncertainty about which services can continue. Lack of communication from a now-decimated USAID department has further eroded trust and sparked fear among both service providers and those who usually rely on these critical services. It now seems that all money flowing from USAID will cease, and that South Africa will lose R3.7bn for the period until September 2025.

Without adequate support for key populations the global goal of “ending Aids” by 2030, set under the UN Sustainable Development Goals, is increasingly unattainable. Weakening these specialised services jeopardises individual lives and undermines public and global health efforts. In other words, this impact extends beyond direct beneficiaries — over time, the collective health and wellbeing of all in South Africa will suffer. The US funding freeze has also sparked concerns about the future of South Africa's health system, with many calling for increased investment in local healthcare initiatives and a reduction in reliance on international aid.

Some of the key points to consider in this context include: * The timeline of events leading up to the funding freeze, including the US government's decision to terminate funding for HIV and health programmes in South Africa * The views of various stakeholders, including healthcare workers, activists, and government officials, on the impact of the funding freeze * The policy implications of the funding freeze, including the potential impact on South Africa's health system and the global goal of ending Aids by 2030 * Statistical data on the number of people affected by the funding freeze, including the number of individuals living with HIV and the number of healthcare workers who will be impacted by the loss of funding * The potential consequences of the funding freeze, including the risk of increased HIV transmission, decreased access to healthcare services, and a decline in the overall health and wellbeing of the population. The SA government has a constitutional obligation to ensure sustainable, corruption-free healthcare that is efficient and well-managed and based on the principles of universal health coverage. Yet these necessary structural shifts cannot come at the cost of millions of lives currently reliant on HIV, TB and other critical services supported by US foreign aid.