On day one of his second term, US President Donald Trump signed an executive order pausing all foreign direct assistance pending a 90-day review. This was quickly followed by a “stop work order” that immediately froze funding for the US President’s Emergency Plan for Aids Relief (Pepfar) — the world’s biggest HIV/Aids support programme, which over the past 20 years has pumped $110bn (R2-trillion) into the countries hardest hit by the pandemic.
These measures threw the South African NGO sector into a tailspin as it put at risk Pepfar-supported programmes in 27 districts countrywide.
With more than 8-million infections and 70% of patients on antiretroviral (ARV) treatment, South Africa manages the largest HIV treatment programme in the world; at national, provincial and district level. It has been highly successful, having cut the number of new infections by 64% between 2001 and 2023.
Now all of this is under threat.
Some 13,000 health-care providers will be laid off unless the Trump administration relents or the shortfall can be made up by the South African government and/or other donors
The National Treasury provides 80% of the money for the treatment programme, with Pepfar responsible for 17% and other global HIV initiatives covering the remaining 3%. One health expert points out that Pepfar funding — some $448.5m (R8.37bn) in the US fiscal year ending September 30 — goes to NGOs that hire the nurses at clinics and other state health facilities to administer ARVs and counsel patients.
This means some 13,000 health-care providers will be laid off unless the Trump administration relents or the shortfall can be made up by the South African government and/or other donors. The consequences will be the return of long queues of HIV patients seeking treatment at public health facilities.
It is feared that some people will fall off the treatment regime, leading to an increase in their viral loads. South Africa and the world cannot afford to return to those dark days when HIV infection was a death sentence.
The Trump executive action and stop-work order are bad news not just for us but the rest of the world. HIV/Aids knows no borders and global infection rates could spike once more.
For South Africa — a middle-income country — hopefully the painful lessons will result in less reliance on donor funding for critical health needs, and the realisation that US largesse depends on the mood of whichever administration is in power.
Finance minister Enoch Godongwana will present a budget this month that shows once again that we spend more on servicing debt than we do on health care. It’s time to right this wrong.
Would you like to comment on this article?
Sign up (it's quick and free) or sign in now.
Please read our Comment Policy before commenting.