UNAIDS urges U.S. to rethink South Africa HIV funding cuts

UNAIDS pressed the United States to rethink its planned HIV funding withdrawal from South Africa, warning that a sudden pullback would hit the country with the world’s largest HIV burden at the point where its treatment system is still carrying millions of people. Around 7.8 million people in South Africa were living with HIV in mid-2025, and by the end of December 2024, 6.3 million were receiving antiretroviral therapy, still short of the 7.8 million estimated to need treatment.

The U.S. State Department has said it began a phased drawdown of PEPFAR support after what it called South Africa’s failure to make demonstrable progress on policy requests from the administration. It argued that PEPFAR was never meant to be permanent and that South Africa, as a middle-income country, could support its own health programs. UNAIDS and public-health advocates have warned that abrupt funding changes do not simply trim a budget line. They can disrupt medicine supply chains, clinic staffing, testing, prevention and community outreach all at once.

The scale of the risk was laid out in stark numbers. UNAIDS has warned that a permanent stop to PEPFAR-supported HIV treatment and prevention could produce more than 6 million additional HIV infections and more than 4 million additional AIDS-related deaths by 2029 or 2030. In South Africa alone, UNAIDS said about 40 USAID-funded health projects received termination letters during the February 2025 funding freeze, while 8,493 PEPFAR-funded staff were affected. A separate UNAIDS assessment said 15,374 PEPFAR-funded HIV response staff across national and 27 priority districts were hit, with an estimated human resources cost of ZAR 4.6 billion, about USD 250 million.

The human toll has already shown up in daily treatment. UNAIDS said about 222,000 people living with HIV, including 7,445 children under 15, faced disruptions in their antiretroviral supplies. The TB/HIV Care clinic in Tshwane, Pretoria, was significantly affected, underscoring how a funding decision in Washington can translate into closed doors, interrupted care and a harder road for patients who cannot afford missed doses.

South Africa’s own data show both progress and fragility. A June 2025 UNAIDS statement said the country was making gains toward ending AIDS as a public health threat by 2030 if prevention and treatment efforts continued. Researchers cited HIV incidence of 0.44% among people aged two years and older in 2022, equal to about 232,400 new infections. Civil-society groups including Section27 and the Stop Stockouts Project said in May 2026 that HIV and contraceptive services remained uneven after more than two decades of PEPFAR support, a reminder that the cost of withdrawal is measured in clinics, medicines and lives, not diplomacy.