The South Africa HIV crisis has intensified since the Trump administration withdrew USAID support earlier this year. Thousands of HIV-positive South Africans, including sex workers, now struggle to access treatment as clinics that once provided lifesaving drugs shut down across the country.
Gugu, a 54-year-old former sex worker, relied on a USAID-funded clinic in central Johannesburg. When the closure notice arrived, she managed to collect a nine-month supply of antiretroviral drugs (ARVs)—far more than the usual three months. Her supply runs out in September, and she plans to visit her local public hospital next.
Many now share Gugu’s burden. Without access to private, donor-supported clinics, HIV-positive patients must turn to government hospitals. But these facilities require patients to arrive before dawn and wait for hours. Time becomes a luxury that sex workers, who earn their income daily, can’t afford. Gugu says the transition discourages many from continuing treatment.
When Gugu visited the hospital to register, a nurse told her and her friends, “There’s nothing special about sex workers.” Such dismissiveness and stigma make it harder for people in vulnerable groups to stay in care. Gugu fears many will default on their ARVs, not out of negligence, but because they dread the humiliation and delays.
South Africa, home to 7.7 million people living with HIV, had made remarkable progress. UNAids reports that 5.9 million patients receive ARVs, contributing to a 66% drop in AIDS-related deaths since 2010. Before donors pulled funding, new HIV infections and AIDS deaths had reached their lowest levels in three decades.
UNAids warns that recent budget cuts threaten to reverse these gains. The world could face 6 million new infections and 4 million AIDS-related deaths by 2029. The South Africa HIV crisis may widen if leaders fail to act.
These advancements stem largely from PEPFAR (President’s Emergency Plan for AIDS Relief). Former President George W. Bush launched the program in 2003, committing over $100 billion to combat HIV/AIDS worldwide. This initiative funded mobile clinics, research, and outreach programs throughout South Africa, saving millions of lives.
The Trump-era cuts not only closed clinics—they also jeopardized research. South African labs had led trials for pre-exposure prophylaxis (Prep) and Lenacapavir, an injectable ARV that offers six-month protection. These breakthroughs emerged from African-led research aimed at benefiting local communities.
Wits University’s Associate Professor Abdullah Ely leads a lab in Johannesburg’s Health Sciences campus. His team, part of the Brilliant Consortium spanning eight African countries, had prepared vaccine trials based on African research. But once funding dried up, the team halted their progress. Some researchers secured limited support, but the delay could last a year.
The funding loss goes beyond labs. In June, universities requested 4.6 billion rand ($260 million) from the government to cover the shortfall. Officials responded with only 600 million rand—400 million from the state, and 100 million each from the Gates Foundation and Wellcome Trust. The gap remains vast.
Dr. Phethiwe Matutu from Universities South Africa urges the government to step up. “We lead in HIV research, but not for ourselves,” she says. “These setbacks affect global policy and practice.”
Prof. Lynn Morris of Wits University warns that the crisis could trigger new outbreaks of HIV, TB, and other infectious diseases. She says, “We had started to control these epidemics. Now we risk losing that progress.”
Gugu works with an NGO that supports HIV-positive pregnant sex workers. Her team delivers medication, ensures treatment compliance, and supports monthly check-ups. For her, continued access to ARVs means staying alive for the sake of her nine-year-old child.
“I hoped we’d have a cure by now,” she says. “I want to live long enough to raise him. This isn’t just today’s problem—it’s about protecting the next generation.”
Without urgent investment, the South Africa HIV crisis will grow worse. Millions depend on global solidarity to maintain progress. South Africa led the world in HIV prevention and treatment once. With the right support, it can do so again.
READ: UNAids Chief Warns US HIV Aid Cuts Could Lead to Over Six Million Deaths.
