South Africa’s HIV treatment crisis worsens, even after U.S. waiver on aid cuts

The funding cuts, initiated during the Trump administration, forced the closure of 12 nonprofit clinics earlier this year, leaving tens of thousands without reliable access to life-saving medication.

According to The Associated Press, over 63,000 people were receiving treatment in the 12 U.S.-funded clinics that shut down, and as many as 220,000 have since seen disruptions in accessing daily medication.

Experts warn that the funding gap could trigger hundreds of thousands of new infections and tens of thousands of preventable deaths if not urgently addressed.

The South African government has pledged that it will not allow the withdrawal of around $427 million in U.S. support to derail its HIV programme, which remains the largest in the world.

But the impact is already being felt most acutely among the country’s most marginalized groups, especially sex workers and transgender people.

Their testimonies, gathered by The Associated Press, reveal the extent of the disruption:

One HIV-positive sex worker and mother of three said she was left without medication for nearly four months after being turned away at local hospitals.

“The only thing that I could think of was my kids, and that I am going to die, and how am I going to explain to my kids that I am sick because of the line of work that I chose?” she said.

Sex workers and transgender South Africans told the AP that they face heightened difficulties in securing medication, with many speaking on condition of anonymity due to fear of stigma or retaliation.

“In hospital, they said they only give PrEP to people who are in a relationship with someone who’s HIV-positive and trying to have a baby,” one transgender woman said.

Another HIV-positive woman reported resorting to the black market, where prices have doubled and safety is uncertain.

Prior to the U.S. cuts, about 2 million of South Africa’s estimated 8 million people living with HIV were not on treatment. Reasons included limited access to clinics, denial, mistrust of medication, and undiagnosed cases. Now, activists fear this number is growing.

Yvette Raphael, co-founder of Advocacy for Prevention of HIV and AIDS, warns that decades of progress are at risk of reversing, stating,

“We are scared that we are going to see people dying again.”

The Trump administration defended its decision to cut $427 million in funding, claiming it was necessary due to the U.S. being $37 trillion in debt.

Russell Vought, director of the U.S. Office of Management and Budget, stated,

“We’re $37 trillion in debt. So at some point, the continent of Africa needs to absorb more of the burden of providing this health care.”

Although Washington later issued a limited waiver allowing some HIV services to resume globally, the initial cuts left South Africa scrambling to fill the gap. The government has pledged to sustain the HIV response, but overstretched public facilities are already showing signs of strain.

South Africa’s struggle reflects a wider vulnerability across sub-Saharan Africa, which remains heavily reliant on foreign health funding. With over 8 million South Africans living with HIV, nearly one-fifth of the global total, the stakes extend beyond its borders.

The withdrawal of U.S. support highlights the fragile balance between international aid and national capacity in Africa’s fight against HIV/AIDS. Without urgent intervention, health experts warn, South Africa risks sliding backwards in a battle it has led for decades.