President Trump’s sharp reduction in U.S. foreign aid has had a severe impact on South Africa’s HIV response.
The withdrawal of roughly $427 million in support led to the closure of 12 nonprofit clinics, destabilizing the world’s largest HIV treatment program.
These closures left over 220,000 people facing major interruption to daily medication access. Dental labs and testing resources fell sharply, further complicating efforts to monitor treatment effectiveness.
South Africa has more people living with HIV than any other nation—nearly 8 million, one-fifth of whom are not on treatment.
Since the aid cuts, viral load testing has dropped by up to 21% among key groups, threatening progress in identifying and containing transmission.
Vulnerable communities—especially sex workers and transgender individuals—have suffered the most, encountering refusals at public hospitals, soaring prices on the black market, and discrimination when seeking services.
Health officials say they are working to fill the funding gap but stress the resources needed are vast.
Advocacy groups warn that the loss of aid could reverse decades of gains, triggering hundreds of thousands of new infections and tens of thousands of deaths in the coming years.
The broader landscape is also affected. UNAIDS reports major disruptions across East and Southern Africa, including program shutdowns and loss of health workers, even as limited waivers allow partial service restoration.
Researchers warn the abrupt plunge in aid and dismantling of USAID may allow a global rollback in HIV progress, especially if replacement funding doesn’t arrive soon.