Tag: aid cuts

Categories : Healthcare Politics and Regulations HIVTags :

Withdrawal of US Aid Has Hurt South Africa’s HIV Programme

On By ModernMedia
The cancellation of US aid funding to South Africa is harming the country’s HIV response. Source: Unsplash CC0

By Marcus Low and Nathan Geffen

The number of HIV viral load tests is significantly lower than expected, according to an analysis of data from the National Health Laboratory Service which Spotlight and GroundUp obtained through the Promotion of Access to Information Act.

The number of HIV viral load tests recorded by the National Health Laboratory Service (NHLS) is significantly less than expected since February 2025. We are aware of no compelling reason to explain this except the withdrawal of US aid.

All patients in the public health system with HIV are supposed to get viral load tests regularly, usually once a year. These tests are used to determine if HIV is being suppressed successfully in their blood using ARV medicines. If the number of viral load tests declines, it likely indicates either that patients are being lost to the public health system, they are being monitored less diligently, or the system for recording viral load tests has become less accurate. Any one of these would imply a serious hit to South Africa’s public sector HIV programme.

GroundUp and Spotlight used the Promotion of Access to Information Act to request, among other things, viral load test numbers from the NHLS. We were provided a spreadsheet with the number of tests per month for each province from January 2015 to September 2025. 

The current US Administration began taking steps to reduce US aid across the world after Donald Trump was inaugurated as president on 20 January 2025. Billions of rands have been withdrawn from South Africa. This caused some services, especially for vulnerable people — including gay men, sex workers and trans people— to close almost immediately, such as the Ivan Toms Centre in Cape Town and Wits University facilities in Johannesburg. US aid also funded support systems, such as data collection.

Public health experts have accused the government of being in denial about the consequences of the withdrawal of US aid. Health Minister Dr Aaron Motsoaledi has responded defiantly. In May, he stated that a record number of people had been initiated on ARVs over the previous months, a claim disputed by epidemiologists.

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We asked a biostatistician to examine the NHLS data we received. She analysed the change in viral load tests by month and province over time. She found that the number of viral load tests for the period February to September this year is statistically significantly lower than what one would expect based on previous years. This confirms the view of public health experts: the withdrawal of US aid from South Africa has hit the HIV programme badly.

The decline in viral load numbers was previously reported by the Daily Maverick and Reuters for March and April. This was inevitable given the sudden withdrawal of US aid. But the new data shows that the decline has been sustained until September. The decline has occurred in every province except Limpopo.

How Viral Load Testing Performed Against Expectations, Feb–Sept 2025

ProvincePredictedActualDifference% Differencep_value
Eastern Cape545,061463,510-81,551-150.0007
Free State285,423234,671-50,752-180.0002
Gauteng1,210,8911,006,833-204,058-170.0002
KwaZulu-Natal1,475,3601,284,008-191,352-130.0001
Limpopo419,357441,31421,95750.1550
Mpumalanga532,713450,495-82,218-150.0007
North West326,907292,150-34,757-110.0002
Northern Cape64,85558,746-6,109-90.0017
Western Cape324,074290,011-34,063-110.0205
National5,184,6404,521,738-662,902-130.0003
*This table presents the expected and actual numbers of viral load tests conducted by the National Health Laboratory Service in South Africa from February to September 2025.

By looking at the change in viral load tests since 2015, a biostatistician estimated the number of viral load tests that there should have been for the period February to September 2025 using a standard linear regression model. She found that the actual number of tests declined significantly. A p-value less than 0.05 is considered statistically significant. Except for Limpopo, the p-values are substantially less than 0.05 for every province. The analysis takes into account that the NHLS suffered a data hack in 2024, and consequently, there is missing data for a few months.

An even simpler analysis also raises red flags. The absolute number of viral load tests conducted from February to September 2025 (4,521,738) is slightly lower than it was over the same period in 2023 (4,554,463) (due to a cyber attack, the NHLS’s 2024 figures are not a reliable comparison). Given that the number of people on HIV treatment is expected to increase over time and that everyone should be getting at least one viral load test per year, one would expect the number of viral load tests to have increased by a few hundred thousand since 2023.

These results show that the HIV programme has been set back. It is possible that tens of thousands of people have been lost to care. Also possible is that they are disproportionately the most vulnerable patients treated at specialist US funded facilities that closed as a consequence of the funding cuts.

Nevertheless the HIV programme is still successfully treating millions of people and South Africa is far better off than other African countries, such as Mozambique, whose response to HIV is almost entirely paid for with foreign aid.

Fewer patients have viral rebound. But is it a silver lining?

People with HIV who are on ARVs should have, after a few weeks, an undetectable amount of virus in their blood. This is what the viral load test measures. But if the ARVs stop working or a person stops taking their ARVs regularly, the virus will rebound in their blood.

The NHLS counts the number of viral load tests for which patients have more than a thousand copies of HIV per drop of blood. For these patients, the virus has rebounded in their blood.

The percentage of viral rebound cases has come down in 2025.

This might be because the standard ARV regimen has improved. A drug called dolutegravir is now part of the regimen, and it is known to do a better job of suppressing HIV than the drug it replaced a few years ago. This would be the good-news explanation, a silver lining in the data.

But it’s also possible that it’s because vulnerable patients treated in specialist clinics funded by US aid are more likely to have viral rebound and they are the ones who have been lost to the HIV programme. This would be the bad-news explanation.

At this point, we don’t have data to know which explanation of the viral rebound improvement is correct. The situation also varies substantially by province. The real picture might be a complex interaction of multiple factors.

This article was jointly produced by Spotlight and GroundUp.

Republished from Spotlight under a Creative Commons licence.

Read the original article.

Categories : HIVTags :

Response to Aid Cuts and HIV Prevention Injections Dominate Discussions at SA AIDS Conference

On By ModernMedia
Photo by Sergey Mikheev on Unsplash

By Ufrieda Ho

A dire picture for HIV/Aids funding emerged at the 12th South African AIDS Conference, raising the call for resilience, adapting and also for government to raise its game.

The what-next of South Africa’s HIV response will have to be centred on getting back to basics, leveraging on advances in treatment options and learning fast about adapting in a world without US aid for health services.

These were among the key takeaways from speakers at a plenary session at the 12th Southern African Aids Conference held in Kempton Park last week.

Professor Linda-Gail Bekker, executive officer of the Desmond Tutu Health Foundation, in her address took stock of “the incredible devastation around the world” from the virtual overnight shutting off of funds and human resources as Donald Trump returned to the US presidency in January 2025.

“It was $460 million into the wood chipper for us. And the worrying thing is that it could take us back to the harrowing scenes of 2000 [the height of Aids deaths in the country],” she said.

This comes against what she called the two largest challenges for South Africa’s HIV response: sub-optimal 12-month retention in care and viral suppression. Meaning the struggle to keep patients on treatment beyond a year and helping them stay on antiretrovirals that reduce the amount of virus in the body to a minimum.

The picture painted by Bekker and others is bleak, with much uncertainty remaining as to how South Africa might plug the funding holes left by the abrupt US aid cuts.

Bekker shared research by the Health Economics and Epidemiology Research Office (HE²RO), a division of the Wits Health Consortium at the University of the Witwatersrand. Their research shows that the fallout in the next three years could see South Africa experience a 29% to 56% increase in new HIV infections, or an additional 150 000 to 295 000 cases by 2028. Unless the South African government is able to take over services, there could be a 33% to 38% increase, or an additional 56 000 to 65 000 AIDS-related deaths in that period. (Spotlight previously reported on the HE²RO modelling in more detail here.)

The modelling also suggests that government will need additional funding of between $620 million and $1.4 billion (roughly R10 billion to R24 billion) between 2025 and 2028 to replace the local services that received US government funding.

In July, Treasury allocated R763 million in emergency funding to fill the gap, a fraction of what the HE²RO researchers estimate is needed. In addition, the Gates Foundation and the Wellcome Trust pledged R100 million each for research to the South African Medical Research Council on condition that the South African government doubled their contributions, which government committed to over three years. This added up to an R600 million bailout for research, also a fraction of the amount of research funding that has been lost.

The shortfall remains massive. Last year, Pepfar (United States President’s Emergency Funds for AIDS Relief) funds flowing to South Africa totalled over R7.5 billion.

Calls for greater transparency

Throughout the conference, there was also strong calls from attendees and speakers for government to be more transparent about its plans to mitigate the funding cuts and to provide credible data and information about monitoring and measuring of the success of their interventions. This includes details on how it plans to provide all stable patients with enough medicines for six months at a time. Such multi-month supplies mean people have to travel less to collect medicines, thus making it easier to stay on them. Rollout of multi-month dispensing has been very uneven across the country.

Questions were also raised over a lack of full transparency regarding the price of lenacapavir, a breakthrough HIV prevention injection that provides six months of protection per shot. As we recently reported, the South African government will be paying $60 per person per year for the jab, with other donors paying the rest – it is not publicly known how much this “rest” is. The deal was setup by the Global Fund to Fight AIDS, Tuberculosis and Malaria, Gilead Sciences – the company that makes lenacapavir – and several private donors. Last week, Spotlight published an op-ed in which activists questioned the lack of full transparency about the price.

Dr Sandile Buthelezi, director-general for the National Department of Health, told attendees about the possibility of bringing forward the rollout date for lenacapavir from April next year, to possibly as soon as November this year. He did not answer questions about the price negotiations. He did however confirm that negotiations with The Global Fund has seen them commit to ringfencing US$29 million for procurement of lenacapavir over the next two and a half years.

Doing more with less

Having to do more with less, Bekker said at the conference, will mean the need to build a “resilience bridge”. For her, this means preserving the “two most important interventions” of providing continued access to antiretroviral treatment and to HIV prevention treatments – both long-acting injections and prevention pills.

She added that it also means better efforts to reach the population of people living with HIV who have been diagnosed but are not on treatment. In February 2025, government launched its ‘Close the Gap’ campaign aimed at placing an additional 1.1 million people on treatment by the end of this year. Bekker said the number of people living with HIV who are not on treatment is closer to 2 million people. According to Thembisa, the leading mathematical model of HIV in the country, of the roughly eight million people living with HIV in South Africa, around 6.2 million are on treatment.

How South Africa is progressing against the 1.1 million target is not clear. Figures previously shared by Health Minister Dr Aaron Motsoaledi indicated that over half a million people had been initiated on treatment in a matter of months. This raised eyebrows since, on the face of it, it means that people had been started on treatment this year more quickly than at any other time in South Africa’s HIV response. It also wasn’t clear whether the number of people who had stopped treatment had been subtracted from the number starting treatment. Questions Spotlight previously sent to the health department seeking clarification of the numbers went unanswered. Similar questions were also raised in an open letter and an op-ed published by Spotlight and GroundUp. As yet, Spotlight has not seen answers to the questions raised about the numbers shared by the Minister.

“We need to make services [more] amenable to retention so it means multi-month dispensing and differentiated care,” Bekker said. Differentiated care refers to treating people differently based on their needs – for example by not requiring healthy people living with HIV to visit the clinic as often as sicker people.

“Bad policies that reflect ideology and bias, mean the most vulnerable are deterred from assessing the services they need, and this includes our key populations,” she added of the challenges that people like sex workers, members of the LGBTQI+ community and people who use drugs face in clinics where they are judged, harassed or discriminated against.

Dr Lise Jamieson, a senior researcher at HE²RO, echoed Bekker’s sentiments and said a first priority remains to arrest any backsliding of care as South Africa restructures its HIV programme to match the money it has currently. “It is clear that the one thing that we absolutely cannot drop is our HIV treatment programme – it saves lives,” she said.

For Yvette Raphael, the co-founder and co-director of Advocacy for the Prevention of HIV and Aids (APHA), the undergirding socio-economic factors that have given HIV its stranglehold in South Africa remain largely unchanged.

She said: “I am one of the people who are ageing with HIV and suffering from other non-communicable diseases that come with this”, highlighting the need to address the evolving nature of HIV in the country and the need to address it alongside conditions such as diabetes and heart disease.

But she added that it is still teen girls and young women who are at a disproportionately high risk of acquiring HIV. Her message was for better youth-targeted responses that are community-level responses not top-down strategies.

“Make HIV a priority sustained by local and district government structures, not up here in our national and province centres,” she said.

“Make HIV prevention harder to ignore and weave HIV intervention services with skills training and income generating programmes. We know that employment in this country is low, so young people cannot be expected to continue a healthy life without spaces where they can generate income for themselves, this will [in turn] reduce their vulnerability and dependency on older men.”

She added that government had to step up to what should always have been their role as Pepfar funding was never meant to substitute the work of government. Raphael said: “Pepfar was here to support the government in the early days of HIV. However, some of our government officials saw that as a way of evading their responsibility, and we are now here.”

Note: The Gates Foundation is mentioned in this article. Spotlight receives funding from the Gates Foundation, but is editorially independent – an independence that the editors guard jealously. Spotlight is a member of the South African Press Council and subject to the South African Press Code.

Republished from Spotlight under a Creative Commons licence.

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Categories : Healthcare Politics and Regulations HIVTags :

Inside SA’s Multi-million Rand Plan to Fill US Funding Void

On By ModernMedia
Photo by Miguel Á. Padriñán

By Jesse Copelyn

In response to US funding cuts for South African health services and research projects, National Treasury has provided the National Department of Health with hundreds of millions of rands in emergency funds. Spotlight and GroundUp look at how precisely the government intends to spend this money.

Health Minister Dr Aaron Motsoaledi recently announced that National Treasury had released roughly R753 million to help plug the gap left by US funding cuts to South Africa’s health system. Another R268 million is also being released in the following two years for researchers that lost their US grants.

But this may only constitute the first round of emergency funds from government, according to sources we spoke to. The health department is planning on submitting a bid for an additional allocation later on, which will be considered by Treasury. But this will likely only be approved if the first tranche of funding is properly used.

So how is the money supposed to be used? To find out, we spoke with officials from the National Treasury, the National Department of Health and the South African Medical Research Council (SAMRC).

Money for provinces is for saving jobs at government clinics

The current tranche of money comes from Treasury’s contingency reserve, which exists partially to deal with unforeseen funding shortfalls. It was released in terms of Section 16 of the Public Finance Management Act.

Of the R753 million that’s been announced for this year, Motsoaledi stated that R590 million would be going to provincial health departments via the District Health Programme Grant – a conditional grant for funding the country’s public health efforts, particularly HIV, TB, and other communicable diseases. Such conditional grants typically give the health department more say over how provincial departments spend money than is the case with most other health funding in provinces.

To explain how government officials arrived at this figure, it’s worth recapping what services the US previously supported within provinces.

Prior to Donald Trump becoming US president on 20 January, the US Agency for International Development (USAID) had financed health programmes in specific districts with high rates of HIV. These districts were scattered across all South Africa’s provinces, save for the Northern Cape.

The funds were typically channelled by USAID to non-governmental organisations (NGOs), which used the money to assist the districts in two ways.

The first is that NGOs would hire and deploy health workers at government clinics. The second is that the NGOs would run independent mobile clinics and drop-in centres, which assisted so-called key populations, such as men who have sex with men, sex workers, transgender people, and people who inject drugs.

Following the US funding cuts, thousands of NGO-funded health workers lost their jobs at government clinics, while many of the health centres catering to key populations were forced to close.

In response, the health department began negotiations with Treasury to get emergency funding to restore some of these services. As part of its application, the health department submitted proposals for each province, which specified how much money was needed and how it would be used. (Though this only took place after significant delay and confusion).

Since Treasury couldn’t afford to plug the entire gap left by the US funding cuts, the provincial-level proposals only requested money for some of the services that had been terminated. For instance, funding was not requested for the key populations health centres. Instead, the priority was to secure the jobs that had been lost at government health facilities.

As such, the total amount that was requested from Treasury for each province was largely calculated by taking the total number of health workers that NGOs had hired at clinics and working out how much it would cost to rehire them for 12 months.

Rather than paying the NGOs a grant to deploy these workers as was done by USAID, the health department proposed hiring them directly. This meant that they calculated their wages according to standard government pay scales, which is less than what these workers would have earned from the NGOs.

The total came to just under R1.2 billion for all the provinces combined.

Treasury awarded roughly half of this on the basis that the money would be used to finance these wages for six months, rather than 12. This amounts to the R590 million for provinces that was announced by Motsoaledi.

If all goes smoothly and this money is used effectively to hire these staff over the next six months, then a new tranche of Section 16 funding could be released in order to continue hiring them. Funds might also be released to fund the key populations health sites.

A concern, however, is that the money may just be used by provinces to augment their ordinary budgets. If the funds aren’t actually used to respond to the US cuts, then it is much less likely that more emergency funding will be released.

At this stage, it is too early to tell how provinces will use the money, particularly given that it appears that at least some of them haven’t gotten it yet.

Spotlight and GroundUp sent questions to several provincial health departments. Only the Western Cape responded. The province’s MEC for Health and Wellness, Mireille Wenger, said that the funds have not yet been received by her department, but that once they were, they would be directed to several key priority areas, including digitisation of health records, and the strengthening of the primary healthcare system.

It’s thus not clear whether the province will be using any of the funds to employ health staff axed by US-funded NGOs. In response to a question about this, Wenger stated that “further clarity is still required from the National Department of Health and National Treasury regarding the precise provincial allocations and conditions tied to the additional funding”.

What about research?

Of the R753 million that’s been released for this year, R132 million has been allocated to mitigate the funding cuts for research by US federal institutions, primarily the National Institutes for Health (NIH). Unlike USAID, the NIH is not an aid body. It provides grants to researchers who are testing new treatments and medical interventions that ultimately benefit everyone. These grants can be awarded to researchers in the US or abroad as part of a highly competitive application process.

Researchers in South Africa are awarded a few billion rands worth of grants from the NIH each year, largely due to their expertise in HIV and TB. But over the last few months, much of this funding has been terminated or left in limbo. (See a detailed explanation of the situation here).

The R132 million issued by Treasury is supposed to assist some of these researchers. It will be followed by another R268 million over the following two years. The Gates Foundation and Wellcome Trust are chipping in an additional R100 million each – though in their case, the funds are being provided upfront.

All of this money – R600 million in total – is being channelled to the SAMRC, which will release it to researchers via a competitive grant allocation system.

According to SAMRC spokesperson Tendani Tsedu, they have already received the R132 million from Treasury, though they are still “finalizing the processes with the Gates Foundation and Wellcome Trust for receipt of [their donations]”.

The SAMRC is also in negotiation with a French research body about securing more funds, though these talks are ongoing.

In the meantime, the SAMRC has sent out a request for grant applications from researchers who have lost their US money. The memo states: “Applicants may apply for funding support for up to 12 months to continue, wind down or complete critical research activities and sustain the projects until U.S. funding is resumed or alternative funds are sourced.”

“The plan,” Tsedu said, “is to award these grants as soon as possible this year.”

Professor Linda-Gail Bekker, CEO of the Desmond Tutu Health Foundation, told us that the hope is that the grants could fill some of the gaps. “This is a bridge and it is certainly going to save some people’s jobs, and some research,” she said, but “it isn’t going to completely fill the gap”.

Indeed, the SAMRC has made clear that its grants aren’t intended to replace the US funding awards entirely. This is unsurprising given that the money that’s being made available is a tiny fraction of the total grant funding awarded by the NIH.

It’s unlikely that research projects will continue to operate as before, and will instead be pared down, said Bekker.

“It’s going to be about getting the absolute minimum done so you either save the outcome, or get an outcome rather than no outcome,” she said.

In other cases, the funds may simply “allow you to more ethically close [the research project] down,” Bekker added.

For some, this funding may also have come too late. Many researchers have already had to lay off staff. Additionally, patients who had been on experimental treatments may have already been transitioned back into routine care. It’s unclear how such projects could be resumed months later.

In response, Tsedu stated: “For projects that have already closed as a result of the funding cuts, the principal investigator will need to motivate whether the study can be appropriately resurrected if new funds are secured.”

The SAMRC has established a steering committee which will adjudicate bids. They will be considering a range of criteria, Tsedu said, including how beneficial the research might be for the South African health system, and how heavily the project was impacted by the US funding cuts. They will also consider how an SAMRC grant could “be leveraged for future sustainability of the project, personnel or unit”, added Tsedu.

An endless back and forth

The job of the SAMRC steering committee will likely be made a lot more complicated by the erratic policy changes within the NIH. On 25 March, the body sent a memo to staff – leaked to Nature and Bhekisisa – instructing them to hold all funding awards to researchers in South Africa. After this, numerous researchers in the country said they couldn’t renew their grants.

However, last month, Science reported that a new memo had been sent to NIH staff which said that while South African researchers still couldn’t get new grants, active awards could be resumed.

Since then, some funds appear to be trickling back into the country, but certainly not all. For instance, Spotlight and GroundUp spoke to one researcher who had two active NIH awards before the cuts. He stated that one of these was resumed last month, while the other is still paused.

Bekker also told us that she had heard of one or two research grants being resumed in the last week, though she said the bulk of active awards to South Africa are still pending.

“Where people are the prime recipients [of an NIH grant] without a sub awardee, there seems to be a queue and backlog but some [of those awards] are coming through,” said Bekker. “But how long this is going to take and when it might come through, we’re waiting to hear.” She said a strategy might be to apply for the SAMRC bridging funding and “if by some miracle the [NIH funding is resumed]” then researchers could then presumably retract their SAMRC application.

In the meantime, health researchers will have to continue spending their time working out how to respond to the abrupt and increasingly confusing changes to funding guidelines that have dogged them since Trump assumed office.

“It’s such a dreadful waste of energy,” said Bekker. “If we were just getting on with the research, it would be so much better.”

This article was jointly produced by Spotlight and GroundUp.

Republished from Spotlight under a Creative Commons licence.

Read the original article.

Categories : Healthcare Politics and RegulationsTags :

Global Fund to Cut R1.4-Billion to SA for HIV, TB and Malaria

On By ModernMedia
Photo by Reynaldo #brigworkz Brigantty

By Liezl Human

The Global Fund to Fight AIDS, TB and malaria (Global Fund) has notified Health Minister Aaron Motsoaledi that it will reduce funding to South Africa by R1.4-billion.

Global Fund said it would be reducing allocations for the seventh grant cycle from R8.5-billion to about R7.1-billion, a 16% reduction. Of this, 55% would be allocated to the National Department of Health and the rest to non-profit organisations such as the Networking HIV & AIDS Community of Southern Africa, Beyond Zero, and the AIDS Foundation of South Africa.

The fund informed recipient countries in May that it would be revising over 200 grants amidst funding shortfalls.

Global Fund was established in 2002 and provides funding for HIV, TB and malaria programmes in over 100 countries. According to its 2024 results report, 72% of its funding from 2021 to 2024 went to sub-Saharan Africa.

Other African countries also received notification of funding cuts. Mozambique’s allocation decreased by 12%, Malawi’s by 8% and Zimbabwe by 11%.

The shortfall in funding is due to Global Fund not having received money pledged by national governments. Over US$4 billion of the shortfall is due to the United States not fulfilling its pledge.

We reported last month how Mozambique’s health system has crumbled amidst USAID funding cuts.

In South Africa, funding cuts from PEPFAR earlier this year have led to clinics closing down, health staff getting retrenched, and people struggling to access HIV medication.

“As you know, the external financing landscape for global health programs is going through significant changes, with substantial impact on lifesaving services for the fight against the three diseases and health and community systems,” the Global Fund said in its letter to South African representatives.

The letter continued that while the Global Fund has “received some significant donor payments in recent days”, prospects to give the full grant cycle 7 (GC7) pledges “remain highly uncertain” and still face a risk of funding shortfalls.

“This is a difficult and unavoidable decision, which may require your country to reconsider how best to use the remaining GC7 grant amounts together with domestic resources and other sources of funds to keep saving lives,” the Global Fund said.

Foster Mohale, Department of Health spokesperson, said that the funding cut did not come as a surprise. Mohale said the department is “working with the provinces” to ensure that “service delivery” is not disrupted, and to apply measures to ensure “efficient use of limited resources”.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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Categories : Cancer HospitalsTags :

Closure of US-funded Cancer Clinic Further Burdens Public Hospitals

On By ModernMedia
The Cervical Cancer Screening and Prevention Clinic at Helen Joseph Hospital in Johannesburg was forced to shut down in mid-May after losing all its funding from the US President’s Emergency Plan for AIDS Relief (PEPFAR). Photos: Elna Schütz

By Elna Schütz

Hundreds of cervical cancer patients will likely be referred to overburdened hospitals following the closure of the Cervical Cancer Screening and Prevention Clinic at Helen Joseph Hospital in Johannesburg.

Following over 20 years of operations, the clinic was forced to shut down in mid-May after losing all its funding from the US President’s Emergency Plan for AIDS Relief (PEPFAR). It relied on some financial reserves to taper its activities over several months. Most clinic staff have been let go.

The clinic served women who were referred from across Johannesburg and as far as Springs. A significant part of that group lives with HIV.

“Many of these women are from underserved communities with limited access to specialist care,” says Dr Mark Faesen, Specialist Gynaecologist with the Clinical HIV Research Unit (CHRU).

The clinic offered critical cervical cancer screening and follow-up services, including Pap smears and colposcopies – a cervical examination for abnormalities. The clinic was managing around 1,400 patients annually. “It served as a clinical and research hub, preventing many cancers,” Faesen says.

We spoke to Zinhle (name changed) who was screened at the clinic after feeling ill for a year and who sought help at four different hospitals.

“When I got [to this clinic], I was received with a warm welcome,” she says, emphasising that every step of the process was explained to her and she was made to feel comfortable. “Where else are we supposed to go?”

Zinhle says she is deeply upset that she can no longer be treated at the clinic if she needs it again.

Faesen says the clinic’s closure will put immense pressure on other public hospitals offering these services, like Rahima Moosa or Chris Hani Baragwanath. This is likely to lead to longer waiting times for screening, diagnosis and treatments. “Early detection is important,” Faesen says. “Without timely diagnosis, outcomes are far poorer.”

Lorraine Govender, the National Manager of Health Programmes at the Cancer Association of South Africa (CANSA) says they are deeply concerned by the closure, as it is a serious setback in the ongoing fight against the disease.

Cervical cancer is the second most common cancer in women in South Africa, and results in the most deaths. It is curable if diagnosed and treated early. A Human Papillomavirus (HPV) vaccination also reduces the risk of cervical cancer. While low screening rates and backlogs in treatment have been long-standing across the country, Johannesburg appears to be particularly burdened. The shutdown of this clinic adds to a larger shortage of screening and treatment in Gauteng.

The Department of Health has previously stated that while it has improved vaccination efforts against cervical cancer, “screening and treatment are lagging behind”. The national health policy calls for women aged 30 to 50 to be screened at least three times in their lives. Women living with HIV should be screened at least every three years.

Cervical cancer screening services are limited and overwhelmed at most public hospitals, Faesen says. “The funding cuts have a knock-on effect: increasing patient loads at the few remaining colposcopy clinics.”

Lorraine Govender, the National Manager of Health Programmes at the Cancer Association of South Africa (CANSA) says they are deeply concerned by the closure, as it is a serious setback in the ongoing fight against the disease.

“Cervical cancer is both preventable and treatable when detected early, making continued access to screening services vital … The closure of this Johannesburg clinic must be a call to action,” Govender says.

Faesen stresses the urgent need for increased funding for decentralised screening services to fill the gaps created by clinics like the one at Helen Joseph Hospital. “Equipping more public sector sites with colposcopy capability and training personnel is also essential.”

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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Categories : Expert Opinion Healthcare Politics and RegulationsTags :

The Global Fund to Fight AIDS, Tuberculosis and Malaria Should Step up Efforts

On By Peter Van Dyk
Photo by Towfiqu barbhuiya on Unsplash

The international community must protect global responses to HIV, tuberculosis (TB), and malaria to serve humanity’s collective interests, according to an opinion article published May 14, 2025, in the open-access journal PLOS Global Public Health by Gorik Ooms from the Institute of Tropical Medicine, Belgium, and colleagues.

Within days of starting his second term as President, Donald Trump ended most United States (US) contributions to global health. Global responses to HIV, TB and malaria are not the only programs affected but were particularly dependent on US support. The US withdrawal from global health could result in 3 million additional HIV deaths and 10 million additional HIV infections, 107 000 additional malaria deaths and 15 million additional malaria infections, and 2 million additional TB deaths, all in 2025.

HIV, TB and malaria are global health security threats that require international collective action. The Global Fund to fight AIDS, TB and Malaria (Global Fund) entered its replenishment cycle for 2027–2029, with a target of $18 billion. A failure of this replenishment would make it impossible for many countries to compensate for decreasing US funding and decreasing Global Fund support.

The abrupt end of most US funding for global health comes at a crucial moment for the fight against the three epidemics. For HIV, funding cuts are disrupting treatment and prevention, and increasing morbidity, mortality and infections especially among marginalised groups. The transmission of TB remains high due to insufficient access to treatment, urbanisation and undernutrition. Control of malaria remains elusive due to emerging resistance to treatments, and insecticides, gaps in prevention, and limited access to healthcare.

According to the authors, the reduction of US bilateral aid calls for re-prioritisation and enhanced coordination of the global fights against HIV, TB and malaria. Currently, the Global Fund is uniquely positioned to undertake this endeavour, as it financially supports HIV, TB and malaria programs in most, if not all, countries affected by US spending cuts. This requires a successful replenishment, which seems improbable given uncertainty about the US position and considering the aid spending cuts announced by other high-income countries. Low- and middle-income countries need to step in, which necessitates an overhaul of the Global Fund governance.

The authors outline four action points. First, all countries, regardless of income level, should support the current replenishment of the Global Fund. Second, the replenishment mechanism should move toward agreed and fair assessed contributions, such as 0.01% of the annual gross domestic product of all countries. Third, the Global Fund should commit to overhauling its governance structures to promote equal representation among geographical constituencies. Fourth, the Global Fund should commit to adhere to the Lusaka Agenda, which captures consensus around five key shifts for the long-term evolution of global health initiatives and the wider health ecosystem.

As noted by the authors, these four actions would save essential elements of the global responses to HIV, TB and malaria and set a central and collaborative mechanism for global health security on a path toward the principles of global public investment.

Dr Gorik Ooms adds: “Richer countries still view global health cooperation primarily as aid, from them to poorer countries. They do not seem to realise how this cooperation also protects their own interests. We must not only find enough funding to sustain it; but also rethink how we work together. Through genuine international cooperation between equal partners.”

Co-author Dr Raffaella Ravinetto concludes: “It is not only a matter of keeping life-saving programs alive. It is also a matter of building and maintaining a solid ecosystem, encompassing health infrastructure, policies and human resources, to make quality health care feasible everywhere. Through solidarity we can serve common interests.”

Provided by PLOS

Freely available article: https://plos.io/4djaJ2H

In your coverage please use this URL to provide access to the freely available article in PLOS Global Public Health: https://plos.io/4djaJ2H

Contact: Anna Dams, adams@itg.be, Ph.: +32 477 45 88 38; Gorik Ooms, gooms@itg.be, Ph./WhatsApp: +32 465 829 858   

Image Caption: A person holds medications. Limited access to diagnostics and medicines will worsen treatment quality, inducing resistance to antiretrovirals and medicines for infections.

Image Credit: Institute of Tropical Medicine (ITM), Antwerp, CC-BY 4.0 (https://creativecommons.org/licenses/by/4.0/)

Categories : Expert OpinionTags :

Foreign Cuts Force South Africa to Rethink Healthcare with Local Solutions

On By Peter Van Dyk
Operations Executive Lucelle Iyer

Johannesburg, 15 May 2025 – South Africa’s healthcare sector faces mounting pressure as international funding withdrawals threaten critical research and services.

Without the financial support, medical advancements are being jeopardised and access to care for vulnerable communities is limited.

With leading universities bracing for losses exceeding R800 million annually, experts warn of setbacks in disease treatment and public health initiatives. As foreign aid recedes, South Africa must look inward for sustainable solutions to safeguard its healthcare future.

At Adcock Ingram Critical Care (AICC), newly appointed Operations Executive Lucelle Iyer is part of a new wave of industry leaders focused on local solutions. Rather than relying on global models, she is driving efforts to strengthen domestic production and innovation. As public health programmes face uncertainty, the role of private-sector initiatives in sustaining healthcare access is becoming increasingly critical.

South Africa’s ability to bridge healthcare gaps and extend services to underserved communities increasingly depends on local innovation and resourcefulness. As AICC expands its investment in modernising plants and developing local talent through 2025, its initiatives could serve as a model for sustainable pharmaceutical manufacturing in South Africa and potentially across the continent. By focusing on innovation and homegrown expertise, the company is contributing to the broader effort to strengthen self-sufficiency in African healthcare.

The push towards localisation addresses the country’s significant dependence on imported pharmaceutical products and active pharmaceutical ingredients (APIs). In 2024, pharmaceutical imports to South Africa were valued at approximately $2.42 billion USD.1 Even though more than 60% of pharmaceutical products sold in South Africa are formulated locally, approximately 98% of APIs2 used in local formulation are imported.

This reliance exposes the healthcare system to risks like exchange rate fluctuations and supply chain disruptions, highlighting the need for increased local production. “We’ve seen the impact of the fragility of local supply chains on our hospitals, especially in rural and under-resourced areas,” says Iyer. “South Africa needs a manufacturing base that is resilient, scalable, and locally relevant.”

Iyer’s leadership is shaped by a philosophy of resilience, innovation, and strategic execution. As the first woman to lead operations at AICC and one of the youngest professionals to hold such a pivotal role, she has broken barriers in a traditionally male-dominated industry. Her success is driven by a solutions-focused mindset, tackling challenges with a commitment to progress and impact.

Building a future-proof pharma ecosystem

The shift to a local-first strategy is part of a broader sector-wide call for policy support and investment into the domestic pharmaceutical value chain. Experts argue that localisation is not only a health security imperative, but an economic opportunity — capable of generating skilled jobs and retaining healthcare spending within national borders.

“Pharma manufacturing has long been seen as too complex or too costly for the local context,” says Iyer. “But technology has changed that. Smart factories, digital quality control, and automation can make local production competitive.”

AICC’s comprehensive strategy includes:

  • Digitisation of production and regulatory compliance systems
  • Building local expertise in pharmacy, engineering, and biotechnology
  • Collaboration with stakeholders to streamline regulatory frameworks
  • Incorporating sustainability and circular economy principles into packaging and plastics manufacturing

Leveraging compliance for competitive advantage

AICC also challenges the common perception that regulatory compliance limits innovation. Instead, the company integrates compliance strategically into its digital transformation, embedding quality assurance and regulatory preparedness from the outset.

“When systems are designed with compliance in mind from the beginning, it greatly reduces rework and crisis management, turning quality into a driver of efficiency,” says Iyer, who brings extensive experience in regulatory affairs, quality management, and pharmaco-economics to her role.

A pivotal moment for the industry

South Africa’s pharmaceutical sector stands at a crossroads, with the potential to become a regional hub for essential medicines, medical devices, and biosimilars. Realising this ambition, however, hinges on coordinated efforts across public, private, and academic sectors to drive innovation, expand capacity, and ensure long-term sustainability.

“Our goal isn’t to replicate models from Europe or the US,” says Iyer. “It’s about creating a pharmaceutical ecosystem designed specifically for our unique needs – efficient, ethical, and sustainable.”

References:

1. Trading Economics. South Africa Imports of Pharmaceutical Products. April 2025. Available from: https://tradingeconomics.com/south-africa/imports/pharmaceutical-products

2. The Department of Trade Industry and Competition. API Development and Manufacturing https://www.thedtic.gov.za/wp-content/uploads/Opinion-Piece-API-Development-and-Manufacturing.pdf

Categories : HIVTags :

How US Funding Cuts are Forcing Sex Workers to Share HIV Medicines

On By ModernMedia

By Kimberly Mutandiro

Sex workers in Vosloorus, Johannesburg and Springs talked to GroundUp about their struggle to access health services, particularly antiretroviral treatment, since the closures of US funded clinics. Photos: Kimberly Mutandiro

It’s afternoon on Boundary Road in Vosloorus. Sex worker Simangele (not her real name) hopes to secure her next client.

Making enough money to pay rent has always been a concern for Simangele. But now she has a new worry: how to keep up with her antiretroviral treatment.

Two months ago the closure of a mobile clinic — where Simangele and other sex workers in Vosloorus went for checkups and to collect their treatment — left her without access to the life-saving medication.

The mobile clinic was run by the Wits Reproductive Health and HIV Institute (WITS RHI) which heavily relied on US funding. The institute has been providing critical sexual and reproductive health services since 2018. The programme was one of many health facilities forced to halt services at the end of January in the wake of US funding cuts for global aid.

Speaking to GroundUp, Simangele says she ran out of antiretroviral medicines (ARVs) over a month ago and has resorted to borrowing a few tablets from a friend. “I don’t know what I will do because the tablets my friend gets give me side effects,” she says. (Antiretrovirals treat HIV. They have to be taken daily for life.)

She says the clinic closed without any warning or before they could give them transfer letters to public healthcare facilities. She is now dreading having to go to a public facility where she says sex workers are frequently discriminated against, particularly those who are undocumented.

We spoke to a dozen other sex workers in Joburg and in Springs who are worried about defaulting on their antiretroviral treatment following the closure of the Wits RHI clinics. The clinics also provided pre-exposure prophylaxis (PrEP) (to prevent HIV-negative people contracting HIV), and treatments for sexually transmitted infections, TB, sexual reproductive health services, and counselling.

A sex worker shows the last few ARVs she has left.

Another sex worker said, “The minute we go to public clinics, they will need documents, which some of us do not have … Wits made time to listen to our problems as sex workers. Even when we faced challenges with clients, they never judged us.”

Sisi (not her real name), who rents rooms and assists sex workers in Vosloorus, said she’s aware of several sex workers who have defaulted and no longer have access to condoms, lubricants, and treatment for sexually transmitted infections. “The Wits clinic did not discriminate against people without documents and would sometimes provide food, branded T-shirts, caps, and even jobs,” she said.

“Many of us will die”

We visited Zig Zag Road in Springs, where several sex workers said they were out or almost out of ARVs. When asked why they didn’t just go to a local clinic, they told GroundUp about instances where they experienced stigma while trying to access treatment at public clinics.

“I used to receive PrEP to help prevent HIV (from the Wits clinic). We would also receive birth control services. Now I can’t go to a public clinic because we are mocked for being sex workers,” said Siphesihle.

Ntombi, who waits for clients along End Street, attended one of the Wits clinics in Hillbrow which closed down. She said those on PrEP were given transfer letters before the clinic closed.

Other workers nearby told GroundUp that they now pay up to R250 for PrEP, which is more than they can afford.

Sisonke calls for urgent response to crisis

The Sisonke National Movement, which advocates for the rights of sex workers, has been raising the alarm since the closure of US-funded facilities. Before the closures, Sisonke was in talks with National Department of Health through the South African National AIDS Council about the provision of services to sex workers and other vulnerable groups, said the organisation’s spokesperson Yonela Sinqu.

She said that the department never answered activists when they asked what would happen should donor funds no longer be available for these facilities.

She said the plea for assistance without referral letters is made to all provinces, not only Gauteng. However, Gauteng is the only province that has approached us with the crisis of people without referrals, she said.

Department of Health spokesperson Foster Mohale has not responded to requests for comment.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Read the original article.

Categories : Expert Opinion Medical IndustryTags :

Opinion Piece: U.S. Funding Halted, Futures at Stake

On By ModernMedia

Finding a path forward for South Africa’s healthcare workers

Donald McMillan

By Donald McMillan, Managing Director at Allmed Healthcare Professionals

06 May 2025

South Africa’s healthcare system is under serious pressure. The sudden suspension of critical US funding has resulted in the loss of around 15 000 healthcare jobs – many of them linked to HIV/AIDS programmes that served as lifelines for vulnerable communities. Combined with broader public sector budget cuts and a national hiring freeze, the situation threatens to undo decades of progress in healthcare delivery. As public hospitals struggle with fewer staff and shrinking resources, the country is at risk of losing not only jobs, but skills, infrastructure, and hope. But in the face of these challenges, there are still ways to keep services running and people employed. One of them is through Temporary Employment Services (TES), which provides a flexible staffing approach that can help stabilise the system while longer-term solutions are explored.

A healthcare system under pressure

The US aid cut has had an immediate and devastating impact. Programmes focused on HIV, tuberculosis, and reproductive health, many of which were propped up by international donor funding, have been forced to scale back or shut down entirely. Thousands of community healthcare workers, nurses, counsellors, and administrators have found themselves jobless, while patients are left facing longer wait times and reduced access to care.

At the same time, cost-cutting across the public sector has put a freeze on new hires, even in essential departments like health and the impact is already being felt. With public hospitals and clinics stretched thin, they’re unable to take on newly trained doctors and nurses. And while the private sector plays a role, it simply cannot absorb the overflow. This isn’t just a staffing issue, it’s a setback for the entire healthcare system, affecting everything from medical training to frontline care.

Young professionals left in limbo

Every year, South Africa produces thousands of highly trained doctors and healthcare workers, many of whom move into the public health system after completing their compulsory community service. These roles used to be a given but with hiring freezes and shrinking budgets, many young professionals are now finishing their training with nowhere to go. Despite their skills and frontline experience, these workers are left in limbo. This is a double blow as South Africa loses out on the return from its investment in their education, while the risk of a growing skills drain looms large. With countries like the UK, Australia, and Canada actively recruiting healthcare workers, there’s a real chance they may leave and not come back.

A flexible solution in Temporary Employment Services

In response to this crisis, temporary employment solutions have become a practical and effective solution. TES providers offer qualified healthcare professionals short- to medium-term flexible contracts, enabling them to continue working in their field while delivering essential support to overburdened healthcare facilities.

This approach offers a lifeline not just for displaced workers, but for clinics and hospitals struggling with limited resources. TES employees can be rapidly deployed where they are needed most, whether to cover staff shortages, serve remote communities, or support seasonal fluctuations in demand. Unlike permanent hires, they don’t carry long-term costs such as medical aid or pension contributions, making them a more budget-conscious option in uncertain times.

The benefits of the TES model have already been proven. During the COVID-19 pandemic, temporary staff played a key role in scaling up testing, vaccination, and treatment efforts across the sector. That same adaptability is needed now to respond to the healthcare funding crisis.

Rethinking the future of healthcare work

While temporary employment solutions cannot not solve the problem alone, it can provide an important stopgap and potentially a new way of thinking about workforce planning in the healthcare sector. Rather than relying solely on permanent positions, South Africa may need to adopt a more fluid, demand-based deployment model that allows professionals to move between roles, regions, and areas of urgent need.

Shifting to this model calls for a change in mindset. Permanent posts have traditionally been seen as the gold standard in healthcare, valued for their stability and benefits. But in a time of uncertainty, contract and locum roles – especially when managed by trusted TES providers – can offer a practical alternative, combining income, ongoing experience, and flexibility.

Retaining talent, restoring hope

Avoiding long-term damage to South Africa’s healthcare system will require urgent, coordinated action. Government departments must urgently reprioritise spending toward essential services like health and education. At the same time, private healthcare providers and staffing agencies must step up and work together to ensure that skilled professionals are not lost to the system or the country.

Despite the current turbulence, South Africa’s healthcare workers remain among the best trained and most resilient in the world and with the right support structures, including flexible employment options like TES, we can preserve our healthcare capacity and continue to serve those who need it most.

Categories : VaccinesTags :

Funding Cuts Risk the Resurgence of Preventable Diseases, WHO Warns

On By ModernMedia
Photo by Mufid Majnun on Unsplash

The World Health Organization warns that global health funding cuts are paving the way for a resurgence of diseases that had been brought to the brink by vaccination.

One example of prior success is Africa’s “meningitis belt”, spanning parts of sub-Saharan Africa, where vaccination campaigns had successfully eliminated meningitis A. Likewise, yellow fever and related deaths were drastically cut by improved routine immunisation and emergency vaccine stockpiles.

The WHO says that this hard-won progress is now threatened. “Funding cuts to global health have put these hard-won gains in jeopardy,” warned Tedros Adhanom Ghebreyesus, WHO Director-General.

Outbreaks on the rise

In 2023, measles cases were estimated at more than 10.3 million – a 20% year-on-year increase. In a statement marking the beginning of World Immunization Week, the WHO, UN Children’s Fund UNICEF and their partners warned that this upward trend is expected to continue into 2025.

After years of declining cases in Africa thanks to improved vaccine access, yellow fever is also making a return. The start of 2025 has already seen a rise in outbreaks across the continent, with cases also confirmed in the Americas.

The threat of vaccine misinformation

Vaccination efforts are increasingly under pressure due to a combination of misinformation, population growth, humanitarian crises, and funding cuts.

Earlier this month, a WHO review across 108 countries found that nearly half are experiencing moderate to severe disruptions to vaccination campaigns, routine immunisations, and supply chains due to falling donor support.

“The global funding crisis is severely limiting our ability to vaccinate over 15 million vulnerable children in fragile and conflict-affected countries against measles,” said Catherine Russell, Executive Director of UNICEF.

High healthcare returns on vaccination

Vaccines save around 4.2 million lives each year, protecting against 14 different diseases. Almost half of those lives are saved in Africa.

Despite this, falling investment now risks the re-emergence of diseases once thought to be under control.

Health experts emphasise that immunisation is one of the most cost-effective health interventions. Every $1 invested in vaccines brings an estimated return of $54 through better health and economic productivity.

UNICEF, WHO, and their partners are calling on parents, the public, and political leaders to support immunisation programmes and ensure long-term investment in vaccines and public health systems.

Source: WHO