A recent modelling study commissioned by South Africa’s National Health Department warns that the discontinuation of US funding through the President’s Emergency Plan for AIDS Relief (PEPFAR) could result in a significant surge in HIV infections and deaths by 2028.
Conducted by researchers from the University of Cape Town and the University of the Witwatersrand, the study estimates an additional 150,000 to 295,000 HIV infections and up to 65,000 more deaths if the South African government does not compensate for the loss of PEPFAR-supported services.
South Africa has played a pivotal role in global HIV research, treatment, and prevention efforts. Home to one of the world’s largest HIV epidemics, the country has been at the forefront of groundbreaking clinical trials, including research on antiretroviral therapies, HIV vaccines, and prevention strategies like pre-exposure prophylaxis (PrEP).
Institutions such as the South African Medical Research Council (SAMRC) and the Centre for the AIDS Programme of Research in South Africa (CAPRISA) have made significant contributions to scientific advancements. Additionally, South Africa was among the first countries to implement large-scale treatment programs, setting a model for other nations in tackling the epidemic.
PEPFAR has been instrumental in supporting HIV-related services globally, including in South Africa, where it provided approximately R7.5 billion to nonprofits in 2024. These funds primarily facilitated the employment of health workers in government clinics and the operation of independent health facilities. However, following an executive order by U.S. President Donald Trump in January 2025 that suspended most U.S. foreign development assistance, many of these organisations have been forced to close due to funding shortfalls, says Spotlight.
The study projects that antiretroviral (ARV) treatment coverage, which stood at 78% in 2024, was expected to rise to 81% by 2026. Without PEPFAR funding, this coverage could decline to 70% by 2026, undermining progress made in HIV treatment and prevention.
This situation underscores the critical role of international aid in sustaining public health initiatives and the potential consequences when such support is withdrawn.
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