The department of health has received R753.5m from Treasury to fill the gap left by the withdrawal of US funding for HIV/Aids programmes under the President’s Emergency Plan for Aids Relief (Pepfar).
The withdrawal of the Pepfar funding earlier this year had a significant effect on HIV/Aids programmes in SA, resulting in the closure of clinics, NGOs, the retrenchment of thousands of healthcare workers, and the suspension of community-based outreach programmes. Experts warned the funding cuts could lead to increased HIV infections.
Health minister Aaron Motsoaledi said in a presentation to parliament in February that Pepfar and USAID had been expected to provide R6.27bn in the 2025/26 fiscal year, about 13% of the R48bn HIV/Aids funding anticipated for the period.
In his budget vote speech in the National Assembly on Wednesday, Motsoaledi announced that in addition the Bill and Melinda Gates Foundation and the Wellcome Trust had each pledged R100m on condition that each R100m is matched by R200m from Treasury, and that the money be dedicated to research. Treasury has agreed to it.
“This means we are going to have a total of R600m offered to researchers despite Pepfar having pulled the plug from their work,” Motsoaledi said.
The Bill and Melinda Gates Foundation and the Wellcome Trust would immediately release the total of R200m while Treasury’s matching R400m would be released over three years with the first tranche of R132m (included in the R753.5m) being allocated this financial year.
“These amounts are intended to cover the most urgent needs and further allocations may be considered later,” the minister said.
The research funding will be transferred to the SA Medical Research Council (SAMRC), which will disburse it to the various research institutions and universities.
Motsoaledi said that after the withdrawal of the Pepfar funding the department of health approached domestic and global funders. National Treasury requested it to prepare 10 plans — one for each province and the tenth for national level, as well as a plan for researchers who have played a major part in the fight against HIV/Aids and TB.
The minister said the R753.5m would be mainly spent as follows: R590.4m for service delivery in provinces to be allocated via the comprehensive HIV/Aids component of the district health programme grant; R32m to the national department of health to support the central chronic medicine dispensing and distribution programme and pharmaceutical supply chain management; and R132m to be transferred to the SAMRC to support health research throughout the country.
Motsoaledi also announced that the Global Fund to fight Aids, tuberculosis and malaria in Geneva had signed an access agreement with pharmaceutical company Gilead Sciences to procure lenacapavir, a long-acting injection for HIV pre-exposure prophylaxis. SA has agreed to be one of the first countries in the starting blocks for lenacapavir.
“It is envisaged that the first shipment will reach at least one African country by the end of 2025 — we intend to be such a country and we have already started putting the plan together. Our plan is to offer lenacapavir to young women and everyone at risk to stay HIV-free,” the minister said.
“This represents one of the most significant advances in HIV prevention in decades. As a first long-acting injectable for pre-exposure prophylaxis, which is applied twice a year, lenacapavir expands the HIV prevention choice basket to the highest level yet.
“As the executive director of Global Fund Peter Sands said, this is not just a scientific breakthrough — it is a turning point for HIV/Aids. It is a tool that for the first time can fundamentally change the trajectory of the HIV epidemic. For SA, we regard this as a game changer in our fight against HIV/Aids.”
Health Justice Initiative director Fatima Hassan criticised Gilead Sciences for not disclosing the price at which it would sell lenacapavir to the Global Fund, saying this undermined transparency and the ability of civil society to lobby for lower drug prices.
Motsoaledi outlined the department’s plans to construct new hospitals, particularly in high-demand areas in Gauteng but also in underserved areas.
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