Health professionals, researchers, activists and members of the media gathered in Johannesburg to discuss the future of healthcare services for key populations, including LGBT+ people, in South Africa.
The Aurum Institute hosted a media presentation and roundtable discussion on Friday, bringing together experts to examine the impact of the withdrawal of US government funding and explore solutions for sustaining essential health services.
Funding Cuts Leave Vulnerable Communities at Risk
In a keynote presentation, Jacqueline Pienaar, Senior Technical Director at the Aurum Institute, highlighted the challenges facing programmes, such as Aurum’s own Pop Inn clinics, which were affected by the US government’s 2025 funding cuts.
These cuts led to the unexpected closure of many key population services, which included HIV treatment and prevention as well as the provision of gender-affirming hormone therapy. LGBT+ people were instead referred to public healthcare facilities that may not always provide the same level of expertise, safety or welcoming environment.
Pienaar emphasised that, beyond sexual health services, many of these programmes also offered vital mental health support, human rights advocacy and empowerment initiatives, many of which have now largely disappeared.
She acknowledged that the public healthcare sector has not yet fully met the needs of key populations and warned that disruptions to HIV services could lead to increased HIV drug resistance and a rise in new HIV infections.
Pienaar revealed that, in KwaZulu-Natal alone, more than 800,000 people had experienced disruptions to healthcare services, with LGBT+ people and other key populations among those most severely affected.
“Our people tell us that, ‘I would rather go without ART or PrEP than risk going to a public health clinic’,” she said, noting the very real and justified fear of stigma and discrimination at these facilities.
Community-Led Care Remains Essential
Pienaar proposed a model that would retain targeted, peer-led community outreach to engage key populations within their own communities through health education, HIV testing and counselling, while integrating these services with community-based public health clinics.
She warned that, without proper planning and resources, efforts to rapidly integrate key populations into the public healthcare system risked failing.
Successful integration, she argued, would require adapting services to reflect people’s lived experiences while ensuring healthcare remains accessible, community-led, stigma-free and non-discriminatory.
Panel Highlights Human Cost of Service Disruptions
A panel discussion, moderated by Ditshego Ditshego, followed the presentation and featured Jay Matlou (Access Chapter 2), Matuba Mahlatjie (The Other Foundation), Dr Dulcy Rakumakoe (Quadcare), Rutendo Bothma (Wits RHI) and Jabu Sibeko (South African National AIDS Council).
The panel also included Thandokuhle Khoza, a transgender activist and service user, who gave a human face to those most affected by the loss of services.
“The majority of our sisters have stopped taking their medication,” she said, revealing that she had been unable to access hormone therapy herself since January.
Mahlatjie also highlighted the hundreds of often-overlooked LGBT+ people who lost their jobs when key population programmes closed.
“They may struggle to get employed because of their expression or identity,” he noted. “The funding cuts have cut deep, and those stories have not been told,” said Mahlatjie.
Dr Rakumakoe added that, “when health systems don’t work, it is the most vulnerable who are affected.”
Panellists shared harrowing examples of some transgender women resorting to obtaining medication through illicit channels and even drinking horse urine in desperate attempts to continue hormone treatment.
Despite the many challenges discussed, the panellists remained optimistic that, through sustained engagement, strong partnerships, commitment and innovation, South Africa can build a more effective, inclusive and sustainable healthcare system for key populations.
Pride Flag Tour Will Promote Inclusive Healthcare
The afternoon concluded on a positive and celebratory note with the launch of the Aurum Institute’s Pop Inn National Pride Flag Tour.
Supported by the Global Fund and the South African National AIDS Council (SANAC), the initiative will take the Pride rainbow flag to Pride events and healthcare facilities across 21 regions of South Africa.
Pienaar said the tour aims to “reinvigorate the progress we have made over the last decade… towards health care, health equity and human rights.”
