The case of the minister and the HIV activists: Are we entering denialism 2.0?

In the leafy office park not far from Charlotte Maxeke Johannesburg Academic Hospital, you’ll find them just past the security boom. Dozens of vehicles, leftovers from what were once busy, purposeful operations, sitting under the highveld sun. The engines are dead and the tyres are flat.

Until recently, these brightly painted trucks and trailers emblazoned with Pepfar and USAID logos were on the move — part of a push to take HIV services to groups of people that government clinics often didn’t reach. But that was before US President Donald Trump abruptly stopped all Pepfar funding for HIV and TB projects, which reached South Africa through the US Agency for International Development (USAID), in February.

The rainy Jozi summer and months of doing nothing have left rust spidering from cracks and leaves piling up on windscreens. Parked in a neat row, vehicles from one such organisation, the Anova Health Institute, the nonprofit in South Africa that received the most money from the President's Emergency Plan for Aids Relief (Pepfar), have plastic tape strung between them, flapping in the wind like something out of a crime scene. 

The parking lot is a metaphor for the crisis that has pitted the government against HIV activists and researchers, who warn that we’ve entered another era of denialism courtesy of the Trump administration. 

At a press conference last week, health minister Aaron Motsoaledi gave a public tongue-lashing to the media, activists and researchers, accusing them of making an “AfriForum-style” scene to “spread disinformation”.

But unlike his predecessor Manto Tshabalala-Msimang, who denied the link between HIV and Aids and propagated false cures such as beetroot and garlic, Motsoaledi is a man of science and evidence-based treatment. 

In his first round as health minister, between 2009 and 2019, he presided over the rollout of what has since become the world’s largest HIV treatment programme. And in February, he launched another campaign, to find and treat 1.1-million people who know they’re HIV positive but are not on antiretroviral treatment (ART), by December. 

But a day after the “Close the Gap” project was launched, on February 26, things quickly unravelled when the Trump administration pulled funding for just over half of the US government-funded projects that would have helped the health department to achieve its HIV goals. The remaining US-funded programmes will likely end in September at the close of the US government’s financial year. 

Activists warn that they’ve since seen a horrifying, fast-moving crisis playing out, with ever-increasing numbers of people skipping their HIV treatment or not using prevention methods because NGO clinics have closed.

They say they fear the collapse of the HIV programme they — and the minister — fought so hard for. 

But Motsoaledi says activists are misrepresenting the situation, because US government funding comprises only 17% of the country’s HIV budget of R46bn.

“I want to state it clearly that propagating wrong information about the start of the HIV/Aids campaign in South Africa, in the manner that it is being done, is no different from the approach adopted by AfriForum and its ilk which led Trump to trash the whole country,” Motsoaledi, who is attending the World Health Assembly in Geneva this week, lashed out at the media at a press conference on May 15.

 “I am saying so because we have already been phoned by the funders we have spoken to, who are asking us why they should put their money in the programme that is said to be collapsing. Is their money going to collapse together with the programme?” 

Other than an extra R1bn from the Global Fund for HIV, TB & Malaria, not a cent has been raised to replace US funds. 

“The minister is in denial that there’s a crisis at all”, says Fatima Hassan, a lawyer who played a crucial part in the early 2000s to force the government to give people with HIV free antiretroviral, and who now heads up the Health Justice Initiative. “We have been here before. No amount of finger-pointing will save lives — only urgency, evidence, partnership, proper planning and resources will.

“Once again, South Africa will have to deal with the harmful public health consequences of not just the Trump administration, but also our own government’s failure to adequately plan for months now.” 

Sex worker: ‘I’ve tried to go to the public clinic, but wasn’t helped’

Back in the parking lot, known as the Isle of Houghton, the Anova Health Institute’s six mobile clinics are standing idle.

Over the past three years, they’ve been used to test 4,000-6,000 people each month for HIV in Gauteng — and to put those who tested positive onto ART — in areas where government clinics are either too far from people’s homes to reach easily, or unable to serve certain groups, such as teenagers or gay and bisexual men, who may face snickering neighbours or dismissive health workers at state facilities when they ask for condoms or HIV tests. 

The US government is allowing Anova to keep only two of its mobile clinics, and even those are now out of use because they no longer have money for staff to run them, says one of the institute’s public health specialists, Kate Rees. Since the funding cuts, Anova has had to stop almost all its work helping the government’s district health services to test and treat people for HIV or distribute anti-HIV pills to prevent infection.

The stop-work order is already being felt in the data — March 2025 health department figures show that 30% fewer people took up ART in Joburg than in March 2024, says Rees. 

Joburg is one of the 27 health districts where Pepfar-funded programmes operated. Among these were 12 clinics, across the 27 districts, with tailor-made HIV services for sex workers, transgender people, men who have sex with men, and injecting drug users — groups with a much higher chance of getting HIV than the general population. 

But because of population density, of the 63,322 people these clinics served, 41,996 — two-thirds — lived in Joburg, Motsoaledi explained at the press conference.

As all these programmes have been shut down, people who got their treatment there or collected free condoms, lubricants or anti-HIV medication now have to go to state clinics. 

Motsoaledi says all the patients’ files have been transferred to the nearest government facility. But many have told Bhekisisa they’ve been refused services — often because government nurses tell them they don’t have transfer letters or they “don’t deserve to be helped”.

The HIV advocacy organisation Treatment Action Campaign, and the national sex worker movement Sisonke, confirmed many more such experiences on a webinar hosted last week by Bhekisisa and the Southern African HIV Clinicians Society. 

Motsoaledi says 1,012 clinicians and 2,377 nonclinician workers at government health facilities, most of them in Gauteng, are being trained to make key populations feel more comfortable visiting state clinics for HIV services. 

But, in fact, the health department has been busy with such training for years, the former acting head of HIV in the health department, Thato Chidarikire, told Bhekisisa’s TV programme, Health Beat, in May 2023. 

Despite that, severe discrimination against transgender people and sex workers persists, surveys by the Ritshidze group have shown. 

One sex worker, who is pregnant and fearful she will transmit the virus to her child, told Bhekisisa this month: “I have defaulted on my ART for two months now. I have tried to go to a public clinic, but I wasn’t helped. 

“Sex workers are seen as dirty people who go and sleep around. We even struggle to get condoms. People like me are now forced to do business without protection because it’s our only source of income and it’s the way we put food on the table.”

Have we really put 520,700 people on ART this year? 

Data commissioned by the health minister himself back up HIV activists’ and scientists’ fears about the potential impact of US funding cuts on South Africa’s HIV programme. 

One such modelling study shows that if South Africa fails to replace the Pepfar funds the country has lost, we might see between 150,000 and 295,000 extra new HIV infections over the next four years (in addition to the estimated 130,000 new infections we already have each year) and up to a 38% increase in Aids-related deaths.

Using Pepfar data, the health department calculated it needs an extra R2.82bn to get through the financial year, and the minister’s staff — including Nicholas Crisp, the deputy director-general in the national health department, who did the calculations — told Bhekisisa in April that without replacement funds, South Africa’s HIV programme will be “unsustainable”. 

But at his press conference, Motsoaledi announced that the health department has, in fact, made what HIV scientists such as Ezintsha head Francois Venter describe as “inconceivable” progress with getting people with HIV who stopped treatment, back on their pills. 

According to the minister, government health workers have managed to find close to half — 520,700 — of the 1.1-million people with HIV that they’ve been looking for and put them on treatment.

But, explains Rees, those numbers are incredibly misleading. 

“The minister didn’t subtract the number of people who were lost from care — those who stopped treatment or died — from the people with HIV who started or restarted treatment. If that was the number we were interested in, we would’ve reached our targets years ago,” says Rees.

She says that’s part of the reason South Africa’s total number of people on ART has been lingering between 5.7-million and 5.9-million for the past two years.

“Because of people who fall off treatment, we’re seeing static programme growth. So we’re not seeing significant increases in the number of people on treatment overall. That means that though the 500,000 people they say they’ve now put onto treatment may have been added to the treatment group, another 500,000 who had already been on treatment could very well also have stopped their treatment during this time. In many cases, it’s possibly the same people cycling in and out of treatment.” 

The health department’s struggle — even with US government funding — to keep people on HIV treatment is also reflected in the second “95” of the country’s 95-95-95 goals. To stop Aids as a public health threat by 2030, these UN targets require us, by the end of this year, to have diagnosed 95% of people with HIV and put 95% of diagnosed people onto ART, as well as making sure those on treatment take their pills each day, so they have too little virus in their bodies to infect others (scientists call this being “virally suppressed”). 

The minister said at his press conference, that South Africa is now at 96-79-94, which means we’re struggling to get people who know they’ve got HIV onto treatment, or to prevent those who are on treatment from defaulting on drugs. 

Covid vs the funding crisis 

So, how did South Africa get to a point where the health department and HIV scientists are yet again at loggerheads? 

Not so long ago, on March 5 2020, shortly after South Africa’s first Sars-CoV-2 infection had been confirmed, then health minister Zweli Mkhize put epidemiologist Salim Abdool Karim live on national TV. The scientist’s task was to explain what was known about the unfamiliar new germ — the cause of Covid — that was already causing havoc in the country. For two hours that evening, the nation sat glued to their TV screens to listen to science — an unthinkable scenario just days earlier. 

Abdool Karim was able to do something Mkhize couldn’t: break down the cause of Covid, and explain where we were headed, in language everyone could understand. People were desperate for information and the government used experts — of which there were many — to keep South Africa up to date. Crucially, Abdool Karim wasn’t working for the government. He chaired the Covid ministerial committee, but, like the other scientists who served on it, he wasn’t employed by the government. 

He and others were simply people whose skills the health department was prepared to draw on — ironically, most of them were also HIV scientists, the same people who now feel being snubbed by the government. 

“We saw amazing leadership during Covid,” says Linda-Gail Bekker, an HIV scientist who heads up the Desmond Tutu Health Foundation and was a co-chief investigator of the J&J Covid jab in South Africa. “[Because of the leadership] private funding followed. But we’re not seeing it this time around. My concern is it doesn’t feel like anyone [in the health department] is in charge.” 

It’s not surprising Bekker feels this way. 

The deputy director-general position for HIV and TB has been vacant for five years, since Yogan Pillay, who now works for the Gates Foundation, left the position in May 2020. Health department spokesperson Foster Mohale says interviews for the position have begun only in the past few months. 

Why is information so hard to get? 

During the pandemic, there were daily press releases, vaccine dashboards and almost daily meetings with experts on the Covid ministerial committee. Now, other than the odd press conference, information that should be public, and opportunities for the government to respond to media or doctors’ questions, are nonexistent. 

We’ve seen that first-hand at Bhekisisa. When we co-hosted a webinar on May 8 with the Southern African HIV Clinicians Society, we invited the current acting deputy director-general, Ramphelane Morewane, to answer questions from clinicians and journalists. His office told us he was on leave in the days before it, but “would definitely be there”. 

But Morewane didn’t turn up, no-one was sent in his place, and no-one explained why the health department couldn’t make it. 

As a journalist during Covid, I had the contact numbers of people such as the deputy director-general in charge of vaccines, on speed dial. This time around, I’m struggling to even get simple copies of important government circulars, such as the one instructing government clinics on how to hand out ART for six months at a time, and who qualifies for it.

The health department’s February circular with incorrect guidelines:

Eventually, I got the first version through a nongovernment contact, but the health department had included incorrect guidelines for six-month dispensations. I’ve asked Morewane, the health department spokesperson, and even the director-general, Sandile Buthelezi — whom I’ve always found helpful — for the corrected circular several times. 

I’ve received nothing. 

Why a corrected government circular that will clear up confusion has to be kept a secret is a mystery to me, and many of the doctors I’ve spoken with feel the same way. 

It’s as if government decision-makers now regard the scientists and activists the health department worked with so well during Covid as enemies, rather than allies, some experts say.   

“We need to all put our minds together in a room and work out what our best buys are and how to get those out to the people who need it the most,” explains Bekker. “The government can’t solve this problem on its own.” 

The head of the Southern African HIV Clinicians Society, Ndiviwe Mphothulo, concurs: “History tells our ART programmes have been so successful because the government worked with civil society. People who won’t learn from history repeat the mistakes of history.”

Trans woman: ‘I couldn’t even get condoms’ 

Back in Hillbrow, close to the parking lot with the now unused mobile clinics, a young trans woman is considering buying her antiretroviral pills on the black market. By the end of May, the three-month supply of ART she got from the US-funded Wits Reproductive Health Research Institute clinic, which closed in February, will run out. 

“I’m anxious and depressed, each day,” she says. “At the Wits clinic, I got my treatment without being made fun of and I got self-testing kits for my sexual partners. But, most importantly, I could get mental health [care] for free. 

“My friends visited the government Hillbrow clinic the other day. I couldn’t even get condoms, let alone treatment.”

Additional reporting by Anna-Maria van Niekerk. Graphics created by Zano Kunene and Tanya Pampalone.

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.