Two decades after South Africa’s denialism battle, HIV scientists and government are again at odds, with scientists accusing the Health Minister of denying the impact of US funding cuts, who in turn is blaming activists and media for exaggerating the crisis
In an office park not far from Charlotte Maxeke Johannesburg Academic Hospital squat dozens of vehicles, leftovers from what were once busy, purposeful operations, now 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 President Donald Trump stopped all Pepfar funding for HIV and TB projects, which reached SA through the US Agency for International Development (USAID).
Now, parked in a neat row, vehicles from one such organisation, the Anova Health Institute, the non-profit in South Africa that received the most money from the President's Emergency Plan for Aids Relief (Pepfar), have plastic tape strung between them.
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, writes Mia Malan for Bhekisisa.
At a press conference last week, Health Minister Aaron Motsoaledi slammed 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 the beetroot and garlic cure, 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 roll=out of what has since become the world’s largest HIV treatment programme. And in February, he launched the campaign – Close the Gap – to find and treat 1.1m people who know they’re HIV positive but are not on antiretroviral treatment (ART), by December.
But a day after that project was launched, on 26 February, the Trump administration pulled its funding for more than 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 probably 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 for which they, and the minister, fought so hard. But Motsoaledi says activists are misrepresenting the situation, because US Government funding comprises only 17% of the country’s HIV budget of R46bn.
“Propagating wrong information about the start of the HIV/Aids campaign in South Africa… is no different from the approach adopted by AfriForum and its ilk which led Trump to trash the whole country,” said Motsoaledi.
“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 with the programme?”
But other than an extra R1bn from the Global Fund for HIV, TB & Malaria, not a single cent has been raised to replace US funds.
“The Minister is in denial that there’s a crisis at all,” said Fatima Hassan, head of 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.”
Over the past three years, Anova Health Institute tested 4 000-6 000 people each month for HIV in Gauteng, and put those who tested positive on to ART – in areas where government clinics are either too far from people’s homes to reach easily, or unable to serve vulnerable groups, including teenagers and gay and bisexual men, who may face 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, said 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 Johannesburg than in March 2024, said Rees.
Johannesburg is one of the 27 health districts where Pepfar-funded programmes operated. Among these were 12 clinics, across 27 districts, with tailor-made HIV services for sex workers, transgender people, men who have sex with men, and injecting drug users.
Because of population density, of the 63 322 people these clinics served, 41 996 – two-thirds – lived in Johannesburg, Motsoaledi said.
With all of the programmes now 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 said 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 said 1 012 clinicians and 2 377 non-clinician 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 department, Thato Chidarikire, told Bhekisisa’s TV programme Health Beat in May 2023.
Despite that, severe discrimination against transgender people and sex workers persists, show surveys by the Ritshidze group.
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 Department of Health (NDoH) 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 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 1.1m people with HIV that they’ve been looking for and put them on treatment.
But, explained 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,” said Rees.
She said that’s part of the reason South Africa’s total number of people on ART has been lingering between 5.7m and 5.9m 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 although the 500 000 people they say they’ve now put on to 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 are 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 on to 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?
“We saw amazing leadership during Covid,” said 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 as if anyone in the Health Department is in charge.”
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 said interviews for the position have begun only in the past few months.
Why is information so scarce?
During the pandemic, there were daily press releases, and almost daily meetings with experts on the Covid ministerial committee. Now, information that should be public, and opportunities for the government to respond to media or doctors’ questions, are non-existent.
When Bhekisisa co-hosted a webinar on 8 May 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 department couldn’t make it.
As a journalist during Covid, I had the contact numbers of people, such as the Deputy DG 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.
Eventually, I got the first version through a non-government contact, but the Health Department had included incorrect guidelines for six-month dispensations. I’ve asked Morewane, the department spokesperson, and even the DG, Sandile Buthelezi, 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 to feel the same way.
“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,” said Bekker. “The government can’t solve this problem on its own.”
Head of the Southern African HIV Clinicians Society, Ndiviwe Mphothulo, concurred: “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.”
Bhekisisa – The case of the minister and the HIV activists: Are we entering denialism 2.0?
See more from MedicalBrief archives:
HIV testing drops after aid cuts, but Minister denies system collapse
Government inaction over HIV funding cuts puts millions at risk
Trump’s aid cuts halt crucial SA-led HIV vaccine trials
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