The number of South Africans on antiretroviral treatment remained roughly unchanged from 2024 to 2025, according to new estimates, suggesting that the disruption of US aid for HIV services has slowed the growth of our HIV treatment programme. But, writes Marcus Low for Spotlight, the impact so far is not as severe as some researchers feared it might be.
Just-published figures from Thembisa, the leading mathematical model of HIV in South Africa, show that our HIV treatment programme grew by a mere 40 000 from 2024 to 2025, taking the tally of people on ARVs from 6.14m to 6.18m. The last time year-on-year growth of the HIV programme was below 100 000 was 20 years ago.
These new estimates provide the most reliable big picture numbers so far on how the withdrawal of United States aid has affected HIV in South Africa. The numbers are somewhat complicated to interpret given that year-on-year growth of the HIV programme had already been slowing before the US aid cuts. The estimates can be explored on Spotlight’s HIV dashboard.
Though concerning, the local impact of disruptions to US aid appears not to be as severe as some had feared. In a study published last year in the journal AIDS, researchers estimated that in a worst-case scenario, US aid cuts might lead to a 28% reduction in the number of people receiving ARVs, a 56% increase in new infections, and a 38% increase in the number of Aids deaths from 2025 to 2028.
While the impact of the aid cuts is still unfolding, the new Thembisa numbers suggest South Africa is not on this worst case trajectory.
Among others, the estimates take into account Department of Health data up to August 2025 – roughly six months after the initial aid cuts. The numbers should be treated with some caution, given that some longer-term impacts might look quite different from what was observed in this first six-month period.
The new estimates also suggest that other HIV programme impacts haven’t been as severe as feared, although there are signs that in several areas progress has slowed or stalled.
The number of people starting to take HIV prevention pills decreased from 628 000 in 2023/24, to 579 000 in 2024/25), but the total number of HIV tests performed went up very slightly from 18.6m to 18.7m.
The number of voluntary medical male circumcisions increased from 258 000 to 418 000.
The Thembisa estimates suggest that the Department of Health’s ambitious ‘Close the Gap’ campaign won’t meet its targets. Launched in February 2025, the campaign’s aim was to put an additional 1.1m people on treatment by the end of 2025 and thus to take the total number of people on HIV treatment to around 7m.
The new Thembisa estimates suggest the Health Department fell around 800 000 short of the target and projects that the 7m mark won’t be met in the next few years.
The figures also show that hundreds of thousands of people cycle in and out of treatment every year.
Thus, while more than 700 000 people are thought to have restarted treatment in 2024/2025 and another 180 000 started treatment for the first time, almost as many also stopped taking treatment (which is why the overall increase of people on treatment is only around 40 000).
More than 50 000 Aids deaths
Deaths from HIV remain worryingly high. The Thembisa team estimates that there were 53 000 HIV-related deaths in the year from mid-2024 to mid-2025. This is 1 000 fewer than the 54 000 people with HIV who died of non-HIV-related causes over the same period. On average, people with HIV are thus now slightly more likely to die of non-HIV-related causes than of Aids.
There were an estimated 146 000 new HIV infections in South Africa from mid-2024 to mid-2025. Since this is more than the number of people with HIV who died over the same period (around 107 000), the absolute number of people with HIV in South Africa is still rising.
According to the new model outputs, an estimated 7.9m South Africans had HIV in mid-2025 (12.3% of the population). Careful readers may have noticed that the estimate we reported on last year was 8m. The difference does not indicate an actual year-on-year decline – in last week’s Thembisa publication the HIV prevalence estimates for several years going back have been lowered slightly.
Mixed picture on 95-95-95 targets
South Africa’s progress against the UNAids 95-95-95 targets is mixed. These targets, also adopted in the country’s National Strategic Plan for HIV, TB and STIs, aim for 95% of people with HIV to be diagnosed, 95% of those diagnosed to be on treatment, and 95% of those on treatment to be virally suppressed.
With an estimated 96% of people with HIV having been diagnosed as of 2025, South Africa has exceeded the first of these targets. However, only 82% of those diagnosed were on treatment in 2025 – falling well short of the second target. Around 95% of those on treatment were virally suppressed in 2025, thus reaching the third target.
Note: This article is based on outputs from Thembisa version 5.0 – published on 12 May 2026. We have mostly quoted 2024/2025 figures since they are based on more data, and thus more reliable than the estimates for 2025/2026. We have rounded some numbers to make the text more accessible.
See more from MedicalBrief archives:
Fewer South Africans dying of HIV, but infection numbers rising
Minister says SA will reach HIV treatment goals despite aid cuts
Nearly 5m South Africans placed on new HIV medicines in four years