EDITORIAL: SA must step up amid US HIV/Aids funding cuts

The speed with which US President Donald Trump has moved to terminate funding to HIV/Aids organisations, sever ties with the World Health Organisation and pull support from the global agency UNAids has left healthcare workers and scientists reeling.

It has shocked and frightened people who dedicated their careers to fighting the HIV pandemic and left stranded the millions of people who relied on the organisations they worked for.

In SA, researchers estimate ending US financial support for HIV/Aids programmes could result in more than half-a-million unnecessary deaths, and the same number of new infections over the next decade. That is, of course, unless the government steps into the breach.

SA has the world’s worst HIV/Aids pandemic, with 7.8-million people living with the disease, only 5.7-million of whom are on treatment. For decades, SA has relied on donors, of which the US government was by far the largest, to fund the organisations that filled the gaps in state services. They took care of the patients who required specialised care, set up needle exchanges for injecting drug users, and devised innovative ways to trace people who were not on treatment and support those struggling to maintain their daily pill regimen.

The US government had been expected to provide R6.27bn to SA’s planned HIV/Aids expenditure of R48bn in the 2025/26 fiscal year, according to health department figures. European nations are cutting back on foreign aid to increase defence spending in support of Ukraine’s war effort, and are clearly not going to come to SA’s rescue. Nor is the Global Fund to fight HIV/Aids, TB and malaria, since it too has lost crucial US support.

This leaves the ball firmly in government’s court. The health department now has two vital tasks.

First, it must persuade finance minister Enoch Godongwana to increase funding for HIV/Aids programmes in his revised budget, due to be tabled in parliament on March 12. Treasury needs no convincing of the investment case for HIV/Aids, but it can only augment the HIV/Aids budget if the health department provides it with a compelling and detailed proposal to step up funding, which so far it appears not to have done. Earlier this week, the health department was still scrambling to consult nongovernmental organisations about the impact of Trump’s cuts.

The second, and far more difficult, task facing the health department is to figure out how to ensure continuity of the HIV/Aids services provided by the organisations that have for the past two decades filled some of the biggest holes in its programmes.

A short-term fix might be to use a mechanism such as the Covid-19 Solidarity Fund and raise emergency funds in the hope that some organisations can revive shuttered programmes. But more importantly, the health department needs to take a long, hard look at the reasons why it has not been able to meet the needs of so many HIV patients, and come up with a durable remedy.

There is no time to waste. Lives are at stake.