When Aaron Motsoaledi was first appointed health minister in 2009, he frankly acknowledged the scale of SA’s HIV crisis and moved with speed and determination to tackle it. Within two years, the number of people on antiretroviral treatment had doubled to 1.63-million, and by 2017, annual Aids deaths had halved to about 89,000. The age of denialism that had marred the government’s response to the epidemic under the previous leadership of health minister Manto Tshabalala-Msimang appeared to be well and truly over.
How tragic, then, that as a new crisis unfolds due to US President Donald Trump’s swingeing aid cuts, Motsoaledi appears more intent on haranguing activists and the media than confronting the real issues before him. In an astonishing press conference earlier this month, he indignantly insisted that SA’s HIV/AIDs programmes had not collapsed and accused the media and those raising the alarm of peddling disinformation. Adding insult to injury, he likened them to AfriForum, which campaigns against what it sees as discrimination against Afrikaners.
Nothing could be further from the truth. The fact of the matter is that US support for SA’s HIV/AIDs programmes and scientific research has been slashed, non-governmental organisations that were offering services the state battles to provide have been forced to close and thousands of people working in the HIV sector have lost their jobs.
A double whammy has hit the sector: not only have programmes previously supported by the US President’s Emergency Plan for Aids Relief (Pepfar) been decimated, but the termination of hundreds of thousands of grants from the US National Institutes of Health has left scientists at universities and research institutes reeling. Exactly how much money has been lost is not entirely clear. Some grants have been terminated, others have not been renewed and some appear to be in place until September.
The health department has been scrambling to determine exactly which organisations and posts the US government was funding, what services they were providing, and whether it can do the job for less. It only submitted a bid to the Treasury for additional funding last week, too late to be considered for the latest budget tabled by finance minister Enoch Godongwana.
For Motsoaledi to suggest that those who raise the alarm are acting with malign intent is not only disingenuous but downright dangerous.
What we do know for certain is that over the past three decades, the US was the biggest foreign donor to SA’s efforts to combat HIV, in recognition of the scale of its epidemic, the largest in the world. Pepfar accounted for 21% of SA’s total $1.85bn (R34.85bn) HIV/Aids expenditure in 2023, the latest year for which data is available. Many of the organisations it funded filled gaps in the services provided by the public health system. They ran clinics for marginalised people who often face stigma and discrimination at public healthcare facilities, developed specialised programmes to help breastfeeding women with HIV protect their babies from getting infected, and devised data-driven tools to help find people who were living with HIV but not on treatment.
The media has faithfully drawn attention to the unfolding crisis facing some of SA’s most vulnerable citizens, and reported on studies modelling the effect of the cuts — including one commissioned by the health department itself that concluded if the government did not quickly step into the breach there could be up to 65,000 additional Aids deaths and almost 300,000 extra HIV infections by 2028.
There is, of course, some truth to the minister’s assertion that SA’s HIV/AIDs programme is not collapsing. The millions of people who rely on programmes wholly funded by the state are indeed still getting the care they require. But that isn’t the point. Thousands of healthcare workers have been suddenly made jobless in a stagnant economy, and the termination of the services they provided not only threatens their patients but hampers SA’s goal of eliminating HIV as a public health threat by 2030.
For Motsoaledi to suggest that those who raise the alarm are acting with malign intent is not only disingenuous but downright dangerous.
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