Securing South Africa's HIV Response: The PEPFAR Crisis in South Africa

The fight against HIV has seen remarkable progress over the past two decades, with global initiatives like the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) playing a crucial role in ensuring access to life-saving treatment and prevention services. However, a recent policy shift by the U.S. administration has put this progress at serious risk, particularly in countries like South Africa, which has the largest HIV epidemic in the world.

A new editorial published in the South African Medical Journal (SAMJ) highlights the devastating impact of an abrupt halt in PEPFAR funding, which took effect on February 26, 2025. This funding cut, resulting from an executive order by President Donald Trump on the first day of his second term, has left thousands of healthcare workers without jobs, disrupted vital HIV treatment programs, and threatened the lives of millions of people dependent on HIV care.

Why This Matters

Since its launch in 2003, PEPFAR has provided over $120 billion in global funding, with nearly $8 billion allocated to South Africa alone. This support has enabled access to antiretroviral therapy (ART) for millions, helped prevent HIV transmission, and strengthened healthcare systems across the country. The sudden termination of this funding leaves an enormous gap, potentially leading to hundreds of thousands of preventable deaths and new infections over the next decade.

HIV treatment has advanced significantly, with once-daily pills and pre-exposure prophylaxis (PrEP) effectively reducing the risk of transmission. However, access to these treatments depends on stable healthcare infrastructure and continuous funding. Without PEPFAR’s contributions, South Africa faces a healthcare crisis that could roll back decades of progress.

What can we do about it

The SAMJ editorial outlines several urgent steps, including securing emergency funding, integrating community-led health initiatives, and ensuring that those on treatment remain in care.

APHA is committed to advocating for policies that protect and expand global HIV programs. We urge U.S. lawmakers to reconsider the devastating cuts to PEPFAR and encourage global health partners to mobilize resources that can fill the funding void. Now, more than ever, a collective response is needed to safeguard the health and well-being of millions who rely on these critical programs.

Read the full SAMJ editorial here to learn more about the impact of the PEPFAR funding crisis and the urgent need for action.