South Africa, home to the worlds largest HIV-positive population, is witnessing a significant decline in HIV testing and monitoring services following substantial cuts in US aid, particularly from the President's Emergency Plan for AIDS Relief PEPFAR. This downturn is notably affecting vulnerable groups such as pregnant women, infants, and young adults.
In February 2025, the US Government terminated over 90 of USAID contracts globally, citing national interest. This abrupt cessation led to the closure of approximately 40 USAID-funded health projects in South Africa and the dismissal of around 8,493 PEPFAR-funded staff. Consequently, many clinics have shut down, and essential services like HIV testing, care, and treatment have been severely disrupted.
The impact is profound: viral load and diagnostic testing have plummeted by up to 21 in key demographics. In central Johannesburg, for instance, HIV testing has nearly ceased due to the absence of USAID-linked counsellors who previously conducted community outreach and testing initiatives.
Particularly alarming is the effect on orphans and vulnerable children. The termination of programmes like NACOSA has left an estimated 26 000 children in the Western Cape without critical services, including antiretroviral therapy and psychosocial support.
Health experts warn that these disruptions could lead to increased HIV transmission rates and a resurgence of AIDS-related deaths. Projections suggest that the withdrawal of PEPFAR support without a transition plan could result in approximately 601 000 HIV-related deaths and 501 000 new infections in South Africa over the next decade.