HIV Patients in KwaZulu-Natal Struggle Amid Aid Freeze
Image source: Bhekisisa
In a rural area of South Africa’s KwaZulu-Natal province, 19-year-old Nozuko Majola is contemplating if she has enough money for the one-hour trip to fetch her vital HIV medication. This medicine is typically delivered to her home, which is difficult to reach because of poorly maintained dirt roads.
Majola is among millions in South Africa impacted by a freeze on global foreign aid initiated by former U.S. President Donald Trump. This freeze raises concerns that HIV patients might discontinue their treatment, potentially leading to higher infection rates and more fatalities.
A 2024 report from the Human Sciences Research Council indicates that KwaZulu-Natal has the second-highest HIV prevalence rate in South Africa at 16%, with an estimated 1,300 young individuals likely to contract the virus each week.
In 2022, KwaZulu-Natal reported the highest number of people living with HIV in South Africa, with about 1.9 million affected. Overall, South Africa has over 7.5 million individuals infected with the virus that causes AIDS, more than any other country globally.
Currently, approximately 5.5 million South Africans are receiving antiretroviral treatment, which faces funding uncertainties due to Trump’s suspension of the President’s Emergency Plan for AIDS Relief (PEPFAR). This program contributes over $400 million annually to South Africa’s HIV programs and NGOs, accounting for around 17% of the total funding, according to the Health Ministry.
Globally, PEPFAR is recognized for saving at least 26 million lives since its inception in 2003, as reported by the U.N. AIDS agency.
Recently, a federal judge ordered the Trump administration to temporarily lift the funding freeze, and the U.S. Embassy in South Africa announced that PEPFAR projects would resume under a limited waiver. However, many HIV-focused aid organizations have already closed, leaving notices at their entrances and PEPFAR-branded vehicles parked unused, directing patients to overwhelmed healthcare facilities.
A significant portion of PEPFAR funding is routed through NGOs that run programs supporting government healthcare services.
For Majola and other HIV patients in the Umzimkhulu region, where unemployment is high and many rely on subsistence farming and government welfare, the aid freeze has disrupted their daily lives. “Life will be challenging here, and many people may not adhere to their treatment due to transport difficulties,” she said. “The mobile clinics seldom visit this area.”
The funding freeze has severely affected several groups that can no longer provide treatment, leading to an influx of patients at already strained public health facilities. Besides medication, these programs allowed healthcare workers to conduct HIV tests in remote villages, serving as a vital resource for many, especially those reluctant to visit public facilities due to the social stigma surrounding HIV.
Additionally, nearly 15,000 healthcare workers funded by PEPFAR are now uncertain about their future employment.
About an hour away in the Umgungundlovu district, which has the highest number of HIV cases in South Africa, HIV counselors gathered in a small office to plan how to support patients like Majola. A manager at a nearby health clinic expressed concern over the growing administrative tasks resulting from the withdrawal of PEPFAR-funded staff. “The individuals responsible for administration and data collection, supported by PEPFAR, have left. We are a small facility and cannot handle such a heavy workload,” said the manager, who requested anonymity as they were not permitted to speak to the press.
Nozuko Ngcaweni has been receiving HIV treatment for approximately 30 years. One of her children contracted the virus and died at the age of 17. She noted that the aid suspension has already impacted her community, causing many people to miss their treatments. “Not long ago, we committed to achieving an HIV-free generation by 2030. However, if the situation continues as it is, we will not reach that goal. We will have to contend with fatalities,” she stated.
Mzamo Zondi, a provincial manager of the Treatment Action Campaign, advocates for accessible HIV treatment for impoverished populations and has been monitoring the repercussions of the aid freeze in Umgungundlovu. “Our efforts to combat HIV are likely to decline as we struggle to prevent new infections,” he said. “This is a crucial matter of survival.”
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