Trump administration cuts to HIV programs, research, and diplomatic relations have delt a “triple blow” to South Africa that wastes years of U.S. investment and risks lives in South Africa, the United States, and around the world, according to a new report published today by Physicians for Human Rights (PHR), Advocates for the Prevention of HIV in South Africa (APHA), and Emthonjeni Counselling & Training.
“Wasted Investments, Looming Crisis: The Impact of U.S. Global Health Funding Cuts on HIV in South Africa” documents how U.S. funding cuts have damaged critical health services, dismantled HIV prevention programs, and disrupted world-class South Africa-U.S. research collaboration – all actions that undermine progress against HIV/AIDS and global health security.
“Our documentation shows that U.S. cuts to the HIV response and research funding in South Africa have put years of hard-fought progress against HIV in jeopardy,” said Emily Bass, PHR expert consultant and report co-author. “Short-sighted, sudden withdrawal of funds for critical components of the HIV response will cause long-term harm to infants, children, adolescent girls and young women, and other groups at the highest risk of HIV.”
U.S.-South African research partnerships have led to scientific breakthroughs like lenacapavir, an injectable pre-exposure prophylaxis (PrEP), and updated global guidelines for treating drug resistant tuberculosis (TB) – which directly benefit Americans. By freezing research funding to South Africa, the Trump administration is sabotaging the United States’ own future health and national security.”
Through in-depth oral history interviews with 40 South African doctors, researchers, people living with HIV, and others involved in South Africa’s HIV response efforts, the report finds that U.S. cuts have:
- Wasted hundreds of millions of dollars of investments by abandoning primary HIV prevention programs and technologies designed to support large-scale HIV prevention efforts, including the game-changing new PrEP drug lenacapavir;
- Squandered hundreds of millions of dollars of investments by failing to engage with a unique collaborative research infrastructure including laboratories, data systems, clinical trials platforms, and highly skilled personnel; and
- Recklessly failed to maintain funding to reduce new HIV infections, among young people and adults, and to prevent unnecessary suffering and death among people living with HIV – ultimately leaving populations worldwide, including in the United States, less secure and more vulnerable to illness.
“It’s devastating to have been so close to choice-based programs that made lenacapvir available to adolescent girls and young women alongside other options, with program models we designed together,” said Yvette Raphael, executive director of APHA. “A product without a program won’t have impact – and the United States has wasted years of investment at the worst possible time.”
“The cuts to HIV funding have affected health services for everyone,” said Nomfundo Eland, executive director of Emthonjeni Counselling & Training. “People are waiting longer, leaving without medications or immunization; staff is burning out. We are losing ground against HIV/AIDS every day.”
While last week the United States and the Global Fund announced efforts to expand access to lenacapavir to an additional one million people, the new report published today shows that the U.S. is simultaneously dismantling the public health systems that are needed to scale up this new game-changing drug.
South Africa is home to the world’s largest HIV epidemic; nearly 1000 adolescent girls and young women in South Africa become infected with HIV each week. South Africa has also historically been the largest international recipient of National Institutes of Health (NIH) research funds. South Africa is noted for world-class research institutions, powerful community-led activism, and a skilled research workforce that has enabled advances across HIV, TB, and other infectious diseases, and for developing and rolling out new medical innovations that have directly benefited the United States. South Africa has the rare combination of high HIV and TB rates as well as a strong research infrastructure that allows new strategies and innovations to be tested quickly and efficiently. South Africa is a bell-weather for the global HIV response, and the Trump administration’s damage to South Africa’s HIV prevention and research infrastructure has major health and security implications for the region, globally, and the United States.
Over the course of the last 15 months the Trump administration has disrupted every aspect of the longstanding U.S.-South Africa partnerships and programs, including through the elimination of U.S. Agency for International Development (USAID)-supported programs, elements of the President’s Emergency Plan for AIDS Relief (PEPFAR), the United States’ flagship foreign aid program to respond to the global HIV crisis, and through a Trump executive order banning all foreign aid and suspending all funding for research to South Africa based on spurious claims of white genocide.
“Our report illustrates what an ‘America First’ approach to global health looks like: Lifesaving programs shuttered, world-class research jettisoned, decades of progress against HIV/AIDS jeopardized. All to the harm of not only South Africans but to Americans and the global public as well. These funding cuts are exacerbating health inequities and leaving vulnerable communities behind,” said Thomas McHale, SM, director of public health at PHR and a report co-author. “U.S. policy decisions have resulted in a colossal waste of resources and decades of investments in the global HIV/AIDS response.”
The detailed analysis is paired with a range of insights from people on the frontlines of South Africa’s HIV response, with interviewees describing:
- “Waiting for a big bomb to blow on our face at any time” from unmonitored HIV infections –Government officer
- “The clinics are in crisis.” –Staff member at research institution
- “We are now moving to a point where if we do not take care of our health, we will be forced to take care of our illness.” –Community health educator
- “People are going to die. Hence I was saying, this thing reminds me in 2003, when we were tested to say, ‘Go and wait for a dying.’ People are dying as we speak, as we’re sitting here.” –Person living with HIV
- “It’s just sad that the systems that we’d set up for youth to be able to access LEN (lenacapavir) are kind of being dismantled or being handed over to government that hopefully will be sustained to some extent by government.” –Executive director
Over the past year, South African advocates, activists, clinicians, researchers, and people living with HIV have documented the impacts of the abrupt U.S. funding cuts. The new report builds on this ongoing work and highlights how eliminating crucial funding for HIV prevention, treatment, data-tracking and infection surveillance, and research systems has consequences far beyond the dollar amount removed.
Informed by these new findings, the report authors call on the U.S. and South African governments to stabilize and strengthen community-based services, research infrastructure, and primary prevention. This crisis represents an opportunity to create new and more equitable, efficient, and integrated global health systems. Governments and stakeholders should move beyond historically unequal aid models and build systems that center national ownership, human rights, and equity in public health and service delivery.
In the United States, this requires congressional action to ensure that South Africa continues to receive funding under the America First Global Health Strategy, and that crucial research support is mobilized – while ensuring that U.S. global health and aid agreements with partner countries are grounded in human rights, equity, and mutual accountability. The report authors call on the South African government to prioritize prevention, treatment, and primary care as part of the HIV response in domestic budgets.
Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.