The US government will provide an additional $1.2bn to SA’s HIV/AIDS programmes over the next two years in an urgent bid to help the country bring its epidemic under control.

Describing SA as at a “crisis point”, US global AIDS co-ordinator Deborah Birx said the country would have 10-million people living with HIV by 2030 if it did not find a way to stem the tide of new infections, which stand at 250,000 a year. No government or outside donor could afford to treat so many people, she said.

“We are using our money to say we need to wake up to the new reality that we have to do things differently in order to have a different outcome in SA,” she said in a telephone interview with Business Day on Monday. “We have to figure this out. We can no longer put our heads in the sand and pretend things are getting better.

“Our resources come from the American people, so for us to make this kind of investment says we are deeply worried," she said.

Several countries that had high HIV prevalence had been able to turn the tide of the epidemic, raising questions about why SA had been unable to do so, she said.

“We know we have tools that work. For some reason, the implementation in SA is not resulting in the outcomes that we see in in Malawi, Lesotho, eSwatini, Namibia and Botswana. We are asking ourselves why it is working in other countries and not here,” said Birx, who announced the new investment at the Global Citizen Festival in Johannesburg on Sunday night.

SA has the world’s worst HIV/ AIDS epidemic, with 7.2-million people living with the disease in 2017, according to Unaids. Though it has made progress in getting people on treatment, it is falling behind on its own targets. There were 4.25-million people on treatment by the end of September, against a target of 5-million, according to national treasury documents released during the medium-term budget policy statement in October. 

The US, through its President’s Emergency Plan for AIDS Relief (Pepfar), has provided $6.26bn to SA’s HIV/AIDS programme since 2004, making it the single biggest international donor. It committed $677m to SA for 2018.

The latest announcement lays to rest earlier fears that US President Donald Trump's administration might scale back support to SA. 

The extra US funding will support an HIV treatment “surge” in line with President Cyril Ramaphosa’s commitment to provide treatment to an additional 2-million people by 2020. The surge plan was jointly developed by the US and SA government, and aims to accelerate HIV testing, treatment and retention in care in the 27 health districts hardest hit by the epidemic.

It includes recruiting more healthcare workers, improving access to HIV medicines and targeted interventions for young women and men.

The national health department’s deputy director-general for HIV/TB, child and maternal health, Yogan Pillay said they have been “working with the Pepfar team to see how we re-jig our interventions and our response to the epidemic to take into account the fact that the people we need to reach are changing.”

More effective programmes were needed to reach key target groups, including young people and men, he said.

Pillay said SA had fallen behind on its treatment targets for a number of reasons, including that a significant number of people stopped taking their medication, it was more difficult to reach people with undiagnosed HIV who are otherwise healthy, and the weak exchange rate had increased the price of commodities such as condoms and HIV test kits.

Francesca Conradie, deputy director at the clinical HIV research unit of the Wits health consortium disagreed with Birx’s characterisation of SA’s HIV/AIDS epidemic as a crisis.

“It is not a trivial problem, but it is not a crisis or emergency. We have good public health interventions, and we are getting there,” she said.