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South Africa is grappling with a growing HIV treatment crisis following significant cuts to U.S. foreign aid, leaving some of the country’s most vulnerable populations without consistent access to life-saving medication.
Over 63,000 people lost regular care after 12 nonprofit clinics funded by U.S. aid were forced to shut down. Health experts estimate that up to 220,000 individuals have experienced disruptions in their daily antiretroviral therapy, placing them at greater risk of illness and potential transmission.
Sex workers and transgender individuals, already marginalized by stigma and legal challenges, are among those most affected. Many have reported being turned away from public hospitals or forced to resort to the black market, where medication costs have nearly doubled.
A 37-year-old sex worker and mother of three described going without treatment for nearly four months before receiving a month’s supply from a mobile clinic.
“All I could think about were my children. I feared I would die without explaining to them why I got sick because of the work I do,” she said.
Another woman said she had to buy medication illegally, risking unverified pills, after being denied care at several clinics.
Many who lost access to U.S.-funded services have struggled to transition into public health facilities. Health experts say while a referral letter is recommended, it is not required, yet patients are frequently refused care without one.
Kate Rees of Johannesburg’s Anova Health Institute noted, “People at clinics, whether nurses, security, or even doctors, sometimes turn them away. That shouldn’t happen.”
The South African health department has stated it is unaware of any official policy to deny treatment and encouraged affected individuals to seek help at public facilities. However, reports of discrimination, particularly against sex workers and transgender people, persist.
The disruption is having broader public health consequences. Without regular care, fewer people are being tested or monitored, meaning many are unaware of their viral load, a critical factor in preventing transmission.
Some individuals have opted to stop seeking care altogether due to fear of ridicule or stigma.
“I won’t go back to a clinic where they make fun of me like I’m a clown,” said one transgender woman who is now paying privately for pre-exposure prophylaxis (PrEP).
South Africa, home to more than 8 million people living with HIV, already struggled to ensure full treatment coverage before the cuts. Nearly 2 million were not on therapy even before the closures. Experts now warn of a potential surge in new infections and preventable deaths if gaps in funding are not urgently addressed.
Yvette Raphael, co-founder of the Advocacy for Prevention of HIV and AIDS group, said activists fear losing years of progress:
“We are terrified that we will start seeing people dying again.”
The funding cuts were part of a broader strategy under U.S. President Donald Trump to scale back foreign aid. Officials argued that African nations should bear more responsibility for their healthcare systems, citing U.S. debt concerns.
Although Washington has since issued a limited waiver to resume some critical HIV services, the damage to existing programs has already been felt across South Africa and beyond.
For many on the front lines, the aid withdrawal is seen not just as a policy decision but as a life-threatening setback. “Our lives matter,” said one affected transgender woman. “What they did to us is unforgivable.”
Source: AP News