Prof Colleen Aldous asks: US HIV funding gone — Will SA’s wealthy fill the gap?

South Africa built the world's largest HIV treatment programme — and the loss of US funding is now quietly eroding the infrastructure that makes it work, not just the medicine supply. Professor Colleen Aldous, a medical researcher at the University of KwaZulu-Natal, argues that counsellors, testing, outreach and adherence support — services that kept roughly half of public-clinic HIV counsellors funded — have taken the real hit, citing Reuters and GroundUp reporting. Her proposed fix is: South Africa's wealthiest business leaders and institutions should back an independently governed HIV resilience fund, treating the crisis as both a moral obligation and an economic one..By Prof Colleen Aldous.The withdrawal of US support for HIV programmes in South Africa has created a serious public-health challenge. It has also created a test of national responsibility.South Africa has built the largest HIV treatment programme in the world over the last couple of decades. Millions of people receive antiretroviral therapy through public clinics. Mother-to-child transmission has fallen substantially. HIV is now a manageable chronic condition for many people with access to timely diagnosis, treatment and ongoing care. These gains deserve both acknowledgement and protection.The public conversation has focused mainly on whether the state can and will continue to provide antiretroviral medicines. It has to, and the core treatment programme is still funded by government. But the medicines are only one part of an effective HIV response. A functioning programme also depends on testing, counselling, adherence support, community outreach, laboratory monitoring and reliable data. These services bring people into care and help them stay there. The loss of US funding has affected this wider infrastructure.Reuters reported in April that US funding had previously contributed about 17% of South Africa’s HIV budget. GroundUp and Spotlight reported last year that the funding had supported close to half of HIV counsellors in public primary-care facilities, excluding the Northern Cape. Community programmes, peer education and outreach work have also been affected.The exact scale of disruption requires continued public reporting. Funding cuts have also weakened some of the data systems needed to monitor their effects. Even so, the available evidence points to a clear risk - essential services around prevention, diagnosis and retention in care have been reduced. This matters because HIV care is a long-term relationship between a person and a health system.A person who is never tested cannot start treatment. A patient who receives a positive result without adequate counselling may never return to the clinic. Someone who starts antiretroviral therapy but receives little support may struggle with adherence or disengage from care. Young people and others at risk of HIV need accurate information, accessible prevention options and services where they are treated with dignity. These are practical issues, not abstract public-health ideals. They affect the incidence of new infections, the proportion of people who achieve viral suppression, future hospital admissions and the health of families and communities.I am interested in this issue because it illustrates the gap that can arise between scientific progress and the ability of ordinary people to benefit from it. South Africa has made substantial gains against HIV through research, effective treatment and sustained public-health action. Those gains remain vulnerable when the community services that support prevention, diagnosis and continuity of care are weakened. As a scientist, I am concerned with how evidence is translated into real-world care, particularly for people who depend on public services. The funding withdrawal raises questions about national responsibility, equity and the sustainability of programmes that have saved many lives.The timing is particularly important. HIV prevention is entering a new phase. Long-acting medicines, including lenacapavir, offer the prospect of protection against HIV through twice-yearly injections. This could be a significant advance for people who find a daily prevention tablet difficult to take consistently. It may also offer a more discreet and practical option for some people at substantial risk of acquiring HIV. The value of this innovation will depend on the system that delivers it. Potential users need accurate information. They need voluntary HIV testing before commencing prevention, reliable follow-up and accessible clinics. Health workers need training. Facilities need dependable supply chains, records and referral pathways. Community organisations need the capacity to discuss prevention options in ways that communities trust. South Africa has the scientific expertise, clinical skills and public-health experience required to meet this challenge. It also has a large private sector and many citizens who have benefited from the opportunities this country provides. This is the moment for those with substantial means to invest more deliberately in South Africa’s health infrastructure. South Africa’s most successful business leaders, including those who have built substantial fortunes through mining, finance, telecommunications and investment, should consider a collective, independently governed HIV resilience fund. This is a practical expression of national responsibility. It also makes sound economic sense.Government has the constitutional responsibility to provide healthcare. The Department of Health and National Treasury should identify the posts and services affected by the funding withdrawal, publish a clear recovery plan and protect high-impact prevention and community-care functions. Public accountability is essential. The scale of the problem also requires a broader social compact.Business leaders, high-net-worth individuals, medical schemes, private healthcare groups and philanthropic foundations can help sustain critical services during this period of transition. This need not take the form of scattered corporate social-investment projects or once-off donations. South Africa needs focused investment in interventions that are evidence-based, transparently governed and measured against clear outcomes.A national HIV resilience fund could provide one route. It could support counsellors and community health workers in priority districts, mobile testing and prevention services, adherence and peer-support programmes, and the data systems needed to track care. It could be independently governed, publicly reported and aligned with national and provincial health priorities. People living with HIV and community organisations should have a meaningful role in its governance.Private healthcare groups and medical schemes also have useful expertise. They understand chronic-care management, laboratory services, health-information systems and patient navigation. Structured partnerships could direct this capacity towards strengthening public-sector services, particularly in districts carrying a high burden of HIV.There is an economic case as well as a moral one. HIV affects households, workplaces, schools and communities. Preventable illness creates costs for employers and places further pressure on public hospitals. Strong prevention and reliable continuity of care protect lives, productivity and social stability. Investment now can prevent far greater costs later.International donors have played an indispensable role in South Africa’s HIV response. Their contribution has saved lives and built capacity. The recent funding withdrawal nevertheless shows the danger of leaving essential community-facing services exposed to decisions made outside the country.South Africa has a long history of responding to HIV through collective action. Activists fought for treatment access. Clinicians and researchers generated the evidence. Community organisations reached people whom formal services missed. Government policy eventually followed. The response succeeded because many different sectors recognised a shared responsibility. That spirit is needed again..Read more:.China steps up HIV fight in South Africa amid US funding shortfall.The wealthy in this country cannot solve every public-health problem. They can, however, help preserve the human infrastructure that allows prevention, treatment and care to reach the people who need them. The relevant question is whether South Africa’s most resourced citizens and institutions will choose to participate in that work. The cost of inaction will be measured in late diagnoses, interrupted treatment, avoidable infections and greater pressure on the public health system. South Africa has invested too much, learned too much and achieved too much to allow its HIV gains to erode.SourcesDube L. US aid cuts undermine HIV prevention in South Africa, report finds. Reuters. 21 April 2026. Available from: Reuters.Geffen N, Low M. How much does our HIV response depend on US funding? GroundUp. 13 March 2025. Available from: GroundUp.South African National Department of Health. Primary Healthcare Standard Treatment Guidelines and Essential Medicines List: HIV and AIDS. Updated 4 June 2026. Available from: National Department of Health.Low M. Spotlight’s top 9 health stories to watch in 2026. Spotlight. 19 January 2026. Available from: Spotlight..Sign up for your early morning brew of the BizNews Insider to keep you up to speed with the content that matters. The newsletter will land in your inbox every morning on weekdays. Register here.Support South Africa's bastion of independent journalism, offering balanced insights on investments, business, and the political economy, by joining BizNews Premium. Register here.If you prefer WhatsApp for updates, sign up to the BizNews channel here.

Prof Colleen Aldous asks: US HIV funding gone — Will SA’s wealthy fill the gap?

Related Stories

Climate change set to add SA to Africa’s Malaria map

The R3.7tn PIC needs independent leadership, not another political appointee: Justice Malala

Don’t sleep on medical aid in your 20s

Another strike against NHI (and NOT emigrating): UK maternity deaths rising and worsening