The Trump administration’s freeze on foreign aid has put more than 15,300 healthcare workers’ jobs on the line, health minister Aaron Motsoaledi told parliament on Wednesday.
The personnel affected include doctors, nurses, pharmacists, data capturers and technical experts, most of whom work in the health districts hardest hit by HIV/Aids.
Just hours after his inauguration on January 20, US President Donald Trump signed an executive order pausing all foreign aid for 90 days pending a review to determine whether it aligned with his “America First” foreign policy agenda.
This was swiftly followed by a stop-work order that forced HIV/Aids programmes supported by the US President’s Emergency Plan for Aids Relief (Pepfar) in more than 50 countries to come to a grinding halt.
A partial waiver to Trump’s instruction was subsequently signed by US secretary of state Marco Rubio, but since Wednesday NGOs supported by Pepfar in SA had yet to receive the go-ahead to resume any of their activities.
Briefing parliament’s portfolio committee on health, the minister assured MPs that SA’s supplies of antiretroviral medicines were not threatened by the aid freeze. The government covered 90% of the cost of HIV treatment, with the remainder provided by the Global Fund to fight HIV/Aids, tuberculosis and malaria, he said.
Work was under way to assess the effect of the aid freeze on services in the 27 health districts in which Pepfar-supported organisations operate, and provinces were working on short- and long-term contingency plans, he said.
Pepfar has provided more than R140bn to SA over the past 20 years in recognition that it is home to the world’s biggest HIV/Aids population and has an estimated 7.8-million people living with the disease.
Pepfar’s role in SA has gradually shifted from the procurement and provision of antiretroviral treatment to providing personnel and technical support. It plays a vital role in SA’s efforts to get more people on treatment and retain them in care.
While 96% of the people living with HIV in SA have been diagnosed, only 79% of the people who know their HIV status are on treatment, according to the latest government estimates.
Pepfar and the US Agency for International Development (USAID) contributed R6.59bn of SA’s total R46.8bn HIV/Aids budget for the 2024/45 fiscal year, the minister told MPs.
It’s not as though people living with HIV will have no-one to help them. The question is whether they [state employees] can cope with the work.
— Aaron Motsoaledi
health minister
In 2023/24 the US contributed 17% (R7.5bn) of SA’s total R44.4bn HIV/Aids budget.
The minister emphasised that more than 256,400 staff were employed by provincial health departments to tackle HIV/Aids in the 27 priority districts, compared with the 15,154 paid by Pepfar.
“It’s not as though people living with HIV will have no-one to help them. The question is whether they [state employees] can cope with the work.”
The national health department had 220 staff whose salaries were paid by the US government, said the minister.
Health activists on Wednesday wrote to Motsoaledi, finance minister Enoch Godongwana, international relations & co-operation minister Ronald Lamola and President Cyril Ramaphosa calling on the government to craft a response to the aid freeze and urgently increase the budget for health services.
The letter was signed by the Health Justice Initiative, the Treatment Action Campaign, Section27 and the Cancer Alliance, among others.
The Trump administration’s “cruel and draconian” executive order had already shuttered many organisations and clinics, and affected hundreds of thousands of patients living with HIV, they said.
“We are aware of the temporary closure of multiple organisations and facilities providing essential healthcare services to, among others, sex workers, members of the LGBTQI+ community, transgender persons, and other marginalised communities seeking sexual and reproductive health support.
“We understand that, right now, at least 900,000 patients living with HIV in four districts are directly affected alongside thousands of patients in other districts too.
“The livelihoods and jobs of several thousand healthcare workers are at risk and essential services such as patient tracking and tracing have been suspended in some instances,” they said.
Updated: February 6 2025
The funding currency has been corrected.
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