Loss of US grants for Aids fight huge blow

• Dismayed activists warn gains against HIV epidemic will be lost

US President Donald Trump dealt SA’s HIV/Aids organisations and scientists a catastrophic blow on Thursday, rescinding US Agency for International Development (USAID) grants with immediate effect.

Health activists warned that SA risks losing its hard-won gains against the HIV epidemic if the government fails to step into the breach.

“The whole region is in deep trouble at the moment. It really lets the tiger out of the cage again,” said Desmond Tutu HIV Foundation COO Linda-Gail Bekker, a member of the Community Health & HIV Advocates Navigating Global Emergencies (Change) lobby group.

SA is less dependent on donor support than many other African nations hard-hit by HIV. But it has the biggest burden of the disease, with 7.8-million people living with HIV of whom 5.7-million are on treatment.

Activists said they were dismayed that the draft budget flighted by finance minister Enoch Godongwana earlier this month contained no additional funding for HIV/Aids, and called on the department of health and the Treasury to implement an emergency plan to ensure patients were not abandoned.

“We are calling on the government to step up and do something about what is happening,” said Sibongile Tshabalala, chair of the Treatment Action Campaign, a Change member. “We can’t afford to die. We can’t afford to go back to those years,” she said, alluding to the era before treatment was widely available.

Thousands of USAID-funded organisations around the world received letters from the Trump administration on Thursday cancelling their grants. In SA these include non-governmental organisations (NGOs) supported by the US President’s Emergency Plan for Aids Relief (Pepfar), which provide both technical support and health services, and large research projects that were developing new tools for HIV prevention.

The move stems from the 90-day pause on foreign aid ordered by Trump shortly after he assumed office in January, pending an assessment of whether projects aligned with his “America First” agenda.

While the Treasury funds the lion’s share of SA’s HIV/Aids expenditure, the US government has made a significant contribution and was expected to provide R6.27bn in the 2025/26 fiscal year. Pepfar has played an integral role in helping to provide services to populations such as pregnant and breastfeeding women, migrants, men who have sex with men, adolescents and sex workers. It also

paid the salaries of more than 15,000 healthcare personnel in the public health sector, ranging from highly specialised clinicians to HIV counsellors.

Business Day has seen a copy of the letter sent to grant recipients in SA, which says: “This award is being terminated for convenience and in the interest of the US government, pursuant to a directive from US secretary of state Marco Rubio, in his capacity as the acting administrator for USAID.”

The letter says the award has been terminated because it is not aligned with USAID’s priorities and continuing with it is not in the US national interest.

Pepfar-supported NGOs have for the past two decades worked in SA, providing technical support and running programmes to fill gaps in services offered by the health department. These Pepfar “implementing partners” have received funding via USAID and the Centres for Disease Control (CDC).

By Thursday afternoon, CDC grants remained in place.

Several Pepfar-supported organisations in SA confirmed they had received letters cancelling USAID grants. One of the largest of these organisations employs 3,000 people, 2,800 of whom are to be retrenched with immediate effect.

Public health specialist Helen Rees said thousands of healthcare workers had been retrenched across SA. “I am especially concerned for the community health workers and data capturers who are financially vulnerable and won’t be easily absorbed into the health system,” she said. “For patients and communities, critical services have already been impacted, including following up on positive HIV tests for babies, following up on possible meningitis cases and caring for the most vulnerable pregnant women whose babies are now at risk of contracting HIV,” she said.

USAID also terminated funding to the Brilliant Consortium, a network of scientists in eight African countries that had been poised to begin an HIV vaccine trial, Glenda Gray, chief scientific officer at the Medical Research Council, confirmed.

Funding for a clinical trial combining contraception with HIV pre-exposure prophylaxis has also been terminated, Bekker said. The department of health had not responded to Business Day’s request for comment at the time of publication.