Funding Disruption for HIV and Harm Reduction Services Will Cost Lives So South Africa Must Rethink Our Priorities

South Africa stands at a dangerous crossroads. The abrupt disruption to HIV and harm reduction funding is not just a financial issue—it is a matter of life and death for millions. Since the United States’ (USAID) funding cut under President Trump, South Africa faces an R8 billion shortfall in funding for HIV and AIDS, threatening over 150 NGOs, more than 15,000 health workers, and the very foundation of the country’s fight against HIV, TB, and sexually transmitted infections (STIs). If unaddressed, this setback will not only stall but could reverse our progress, costing lives, especially among our most vulnerable: people who use drugs (PWUD), sex workers, men who have sex with men, and people in prison.

A Numbers Game With Real Lives at Stake

Just look at the facts. South Africa bears one of the world’s heaviest HIV burdens, with approximately 8.45 million people living with HIV—a jaw-dropping 13.9% of our total population. Let that sink in. Among PWIDs (people who inject drugs) alone, HIV prevalence skyrockets to 55%. Hepatitis C rates among this group reach an alarming 83%, compared to only 0.47% in the general population. These are not just statistics; these are human beings—people with families, dreams, and futures—that our health system must protect.

Why Funding Matters: The Hard Costs of Disruption

USAID/PEPFAR’s contributed, up to 17% of all HIV funding responds in South Africa, underpins critical services: Opioid Substitution Therapy (OST), HIV testing, and antiretroviral therapy. The country’s ambitious bid to reach UNAIDS 95-95-95 targets tells a compelling story: we’ve diagnosed 96% of our people living with HIV, treated 79%, and achieved viral suppression in 93% of those treated (as of April 2025). The second “95”—treatment access—is where the cracks show, and where the recent funding cuts have hit hardest.

Following the cut, up to 15,154 health workers face unemployment. Without them, clinics will close. Testing and adherence support will dry up. Overdose deaths will rise because needle exchange and methadone programmes will disappear. That’s not speculation; it’s already begun. When harm reduction sites in Ehlanzeni (Mpumalanga) and Tshwane (Gauteng) closed for just 16 days in early 2025, thousands of clients were left without life-saving services. For people using heroin, cocaine, and methamphetamine—numbering hundreds of thousands nationwide—the result is predictable: higher rates of HIV and hepatitis C transmission, more overdoses, and ruptured trust between our health system and those it serves.

Encouraging people to use public health facilities is little solace. These centres rarely offer the specialized, evidence-based interventions—like NSP and OST—that PWUD need. When access is removed, even temporarily, public health backslides instantly. Relationships fall apart. Decades of inclusion efforts evaporate. People die.

The Domino Effect: Who Will Carry the Weight?

The crisis doesn’t end with PWUD. Key populations—including sex workers, LGBTQ+ communities, and incarcerated people—are left isolated, as the limited waivers in place specifically exclude many life-saving programmes for these groups. A recent court order halted some funding suspensions, but only temporarily, and only in part. Many community services—those crucial for getting people diagnosed, kept on treatment, and virally suppressed—remain in jeopardy.

Consider women in rural areas. Funding cuts will force them to travel farther for contraception and sexual reproductive health care, incurring unbearable costs and risking unsafe alternatives. This is not equity; it is abandonment. These are the services that keep the HIV epidemic from spiralling, and now they hang by a thread.

Beyond Numbers: The Cost of Reversing Progress

Community-led services are the backbone of South Africa’s HIV response. They provide referrals, counselling, ongoing support, and safe spaces to access care. When funding dries up, these organisations shrivel. Unlike large health systems, most NGOs do not have reserve funds to weather long-term droughts. This means more people will drift away from care, drop out of treatment, and become invisible to the system once again.

Worse, the knock-on effect of these cutbacks will persist for years. Every client lost, every overdose unprevented, every infection missed, sets in motion a public health crisis that magnifies over time—overwhelming our hospitals, undermining social stability, and stoking the flames of drug-resistant TB and HIV strains.

We Need a United Response

Private donors, high net-worth individuals, and the business community must step into the breach. Global partners—like the EU—can cushion some blows. But ultimately, South Africa must decide: will we continue to let our most marginalized communities bear the brunt of global politics? Or will we lead with compassion, evidence, and basic human decency?

The costs of inaction are already visible. The loss of even a single health worker, a single harm reduction site, a single client lost to the system, ripples outward in ways we cannot easily reverse. Let us not wait for tomorrow’s headlines to remind us of the lives we could have saved.

The solution is clear: We must ringfence funding for harm reduction and HIV-related services. National and city governments must prioritize direct, emergency funding to NGOs facing cuts. We need transparency on how remaining international funds are allocated. Above all, we must treat drug use as a health issue, not a criminal one, and ensure every person can access judgment-free, evidence-based services.