Civil Society: Government Must Step Up to Address Trump’s HIV Funding Cuts

 

More than 200 individuals and 60 organisations, led by prominent activists Zackie Achmat and Anneke Meerkotter, have called on South Africa’s government to urgently respond to the “catastrophic” HIV funding cuts by the United States.

In an open letter sent to President Cyril Ramaphosa, Health Minister Dr Aaron Motsoaledi, Finance Minister Enoch Godongwana, and other national and provincial leaders, the signatories warn of the devastating consequences of the abrupt withdrawal of international funding, particularly from PEPFAR (the US President’s Emergency Plan for AIDS Relief).

“The United States has placed the more than 20 million people living healthily with HIV on ARVs supported by PEPFAR on death row through its funding cuts,” the letter states. “This is having a catastrophic effect on individual health as well as public and global health,” states the letter.

“Instead of relying on the energy, knowledge, expertise and power of civil society and movements in South Africa on how to ameliorate these cuts and draft an urgent Plan to do so, our country’s political leaders have argued while box-ticking its ‘consultations with civil society and donors’,” assert the signatories.

Billions Lost, Lives at Risk

Since January 2025, South Africa has lost approximately $261 million (R5.2 billion) in health and research funding from PEPFAR/USAID and the National Institutes of Health.

This includes funding critical to the prevention and treatment of HIV and TB, two of South Africa’s most pressing public health challenges. Specialised clinics providing HIV and related services to key population groups such as men who have sex with men and transgender women have been forced to shut down as a result of the cuts.

Adding to the crisis, the Global Fund has also indicated it will be reducing its allocations to South Africa in its latest grant cycle.

The consequences are dire. Modelling by researchers Meyer-Rath et al. projects that:

“Over 2025–2028, discontinuing PEPFAR funding in South Africa without replacement by [the South African Government] would result in 150,000–296,000 additional new HIV infections (a 29–56% increase) and 56,000–65,000 additional AIDS-related deaths (a 33–38% increase).”

If services currently supported by PEPFAR are permanently discontinued, that number could soar to over 2 million additional infections and more than 700,000 AIDS-related deaths over the next 20 years.

A Call for Transparency and Action

The letter accuses government leaders of dragging their feet while the crisis unfolds, stating that “no efforts have been made by any governmental agency” to meaningfully engage with civil society or to present a detailed plan.

Despite one public parliamentary briefing and vague references to seeking support from the National Lottery, the signatories say no clear emergency plan has been presented, leaving Parliament, provincial governments, and civil society “in the dark.”

A Roadmap to Save Lives

To address the crisis, the letter outlines the urgent need for a fully-costed emergency HIV plan, with five key components:

• Fully-costed national and provincial plans to allocate emergency Treasury funding to lifesaving programmes.
• Continued support for people on ARVs and TB treatment, including adherence and reintegration efforts.
• Focus and resources for HIV testing and prevention including active case-finding and sustained access to PrEP and PEP;
• The reinstatement of services for key populations, with continued training on equality, dignity and privacy for health workers.
• Stronger data collection, management and oversight including continued support for community-led monitoring.

The signatories demand a formal response by 7 July 2025, including:

• The Minister of Health provides information on the current impact of the US funding cuts from, among others, health districts, the National Health Laboratory Services and the National Department of Health;
• The Minister of Health provides the details of National Government’s emergency plan to address the HIV funding crisis;
• The Provincial Health MECs provide the details of the Provincial Governments’ emergency plans to address the HIV funding crisis; and
• National Government agrees to meet with civil society and Health sector leaders to review the emergency plan to address the HIV funding crisis.

Voices Behind the Letter

This urgent appeal is championed by Global HIV Treatment Coalition and Achmat and Meerkotter, co-founders of the Treatment Action Campaign (TAC), an organisation with a history of successfully pressuring government to improve HIV access and equity.

Among the individual signatories are activists, academics, religious leaders, doctors, artists, and people living with HIV. Institutional backers range from Amnesty International South Africa to Triangle Project, Health Justice Initiative, Lawyers for Human Rights and Sex Workers Education and Advocacy Taskforce (SWEAT).

A Preventable Crisis

The letter paints a stark picture: without decisive action, tens of thousands of lives could be lost, not due to a lack of medical solutions, but, say the signatories, due to financial and political inaction.

The clock is ticking for South Africa’s leaders to step up, or risk presiding over an entirely preventable public health disaster.