CAPE TOWN – A coalition of South African civil society groups have urged South Africa’s President Cyril Ramaphosa to “step up” and lead a coordinated national and regional response to prevent “mass healthcare disruptions, preventable deaths, and surges in new HIV infections and drug resistance,” in the wake of the US President Donald Trump’s cut off of aid to the country. 

Trump last week issued an Executive Order halting all aid to South Africa, citing “unjust racial discrimination” against the country’s Afrikaner farmers as well as the country’s case against Israel at the International Criminal Court, alleging genocide in Gaza. The Trump order was referring to a new South African government law that makes it easier to expropriate unused land from white landowners without compensation – when it’s deemed to be in the “public interest“. The new law is being challenged in court.

“Action is critical, particularly in his role as the African Union (AU) Champion on Pandemic Prevention, Preparedness and Response (PPPR) and as South Africa takes on the G20 Presidency,” said the coalition, Community Health and HIV Advocate Navigating Global Emergencies (CHANGE), in a statement on Saturday.

A few organisations have received waivers, but many haven’t

While a few South African organisations delivering HIV and tuberculosis services through the US President’s Emergency Plan for AIDS Relief (PEPFAR) confirmed to Health Policy Watch that they had received PEPFAR waiver letters on Saturday exempting them from the 90-day freeze on PEPFAR activities, originally announced in late January, many others have seen activities cut or curtailed.

However, in light of the most recent Trump order, there is uncertainty about the fate of all PEPFAR-supported South African programmes beyond the 90 days exemption period. Meanwhile, the US Agency for International Development (USAID), which disburses a significant portion of the PEPFAR funding, is being dismantled and PEPFAR’s long-term future is in doubt as its budget comes up for consideration before the US Congress in late March.

Adding to the confusion, several other organisations have not received waivers, while forcing them to cut certain activities. 

For example, at least 9,000 people have lost access to needle exchange and opioid substitution therapy (OST), according to the South African National AIDS Council’s (SANAC) civil society forum.

Funding for HIV clinics catering for those most vulnerable to HIV – “key populations” including sex workers, men who have sex with men and trans people – is likely to be cut permanently.

Funding for a game-changing intervention for groups vulnerable to HIV – twice-yearly injections of lenacapivir that are 100% effective in preventing HIV infection or pre-exposure prophylaxis (PREP) has also been cancelled, according to various reports.

Calling on Ramaphosa to “personally intervene” 

CHANGE has urged President Ramaphosa to “personally intervene before the situation worsens and to ensure a whole-of-government and civil society response.”

“The reckless freezing of US foreign aid is nothing short of a death sentence for thousands of people in South Africa,” warned Sibongile Tshabalala, chairperson of the Treatment Action Campaign (TAC) which advocates for people living with HIV.

“Critical healthcare infrastructure is being dismantled, clinics forced to close, frontline workers without support, all while lives hang in the balance. We are watching decades of progress on HIV being decimated.” 

Historically, South Africa has had one of the highest rates of HIV infection in Africa and in the World.  However, rates of new infections have declined sharply thanks to aggressive campaigns to get those infected on anti-retroviral drugs.  Overall HIV prevalence is about 14% in South Africa, and nearly 20% amongst people aged 15-49 years.

No idea what is happening – people are going to start dying soon

“Health workers and people have no idea what is happening across the region. People are going to start dying soon. Can you imagine being dependent on treatment to save your life, and having it snatched away from you like this, with no alternative?” warned HIV clinician Dr Francois Venter, who directs the Ezintsha research centre in Johannesburg.

Fatima Hassan, head of Health Justice Initiative (HJI), confirmed that while some projects had been given waivers “the issue is still the concern about key populations and what the waiver seeks to cruelly limit”.

“The loss of US government funding has left sex workers without life-saving healthcare, HIV prevention, and critical support. Without these services, they face higher risks of violence, stigma, and disease—pushing them further into isolation and vulnerability,” said Kholi Buthelezi of Sisonke, the National Sex Worker Movement of South Africa.

Grassroots organisations that fund outreach workers, peer educators, and service providers have been “left destitute”. “While the communities they serve face even greater barriers to safety and healthcare. Without urgent funding, these lifelines will disappear, leaving sex workers more isolated and at risk than ever,” said Buthelezi.

In light of the additional orders directed at South Africa, communities are also calling on Ramaphosa to use “all available domestic, as well as compulsory measures,” to ensure that life-saving tools and medicines reach all who need them.

Image Credits: UNAIDS, AIDS Healthcare Foundation, Witkoppen Clinic, TAC, UNAIDS.