The Trump administration’s cuts to HIV funding for South Africa threaten the government’s planned rollout of the HIV prevention shot lenacapavir, warns a new report from the US nonprofit Physicians for Human Rights (PHR).
Lenacapavir has been hailed as a potential game-changer in the fight against HIV/Aids, as the twice-yearly injection provides almost complete protection against HIV.
The health department received its first shipment of lenacapavir earlier this month, but the withdrawal of US funding has eviscerated the systems required to provide it, says the report.
South Africa is home to 17% of the world’s HIV population, with an estimated 8-million people living with the disease. While the government provides the lion’s share of the country’s HIV funding, the scale of South Africa’s epidemic means it has historically received extensive support from the US and other donors. In January 2025, US President Donald Trump signed the first in a series of executive orders that dealt a severe blow to HIV funding in South Africa.
The report, released on Tuesday, drew on interviews with 40 South African doctors, researchers, people living with HIV and others involved in South Africa’s efforts to combat HIV.
It concluded that the Trump administration had wasted hundreds of millions of dollars in previous investments by abandoning HIV prevention programmes and technologies designed to support large-scale HIV prevention efforts, including lenacapavir, it said. South Africa was one of the countries that participated in the pivotal clinical trial demonstrating in 2024 that lenacapavir provides women with complete protection from HIV infection.
“Our report illustrates what an ‘America First’ approach to global health looks like: life-saving programmes shuttered, world-class research jettisoned, decades of progress against HIV/Aids jeopardised. All to the harm of not only South Africans but to Americans and the global public as well,” said Thomas McHale, director of public health at PHR and a report co-author.
“US policy decisions have resulted in a colossal waste of resources and decades of investments in the global HIV/AIDS response,” he said.
The specialised HIV prevention programmes that had been built in South Africa to provide medicines that protect people from the virus, such as cabotegravir, have collapsed since the US government cut the support it had, for decades, provided to South Africa via the President’s Emergency Plan for Aids Relief (Pepfar), said Francois Venter, executive director of the Ezintsha research institute at Wits.
“For lenacapavir to work, you need a delivery platform. But the systems have been almost completely dismantled,” he said.
Health department spokesperson Foster Mohale said lenacapavir will be offered through the present primary healthcare system.
“South Africa’s real advantage is not only that it has a well-established PREP (pre-exposure prophylaxis) programme, which is built on a strong public-sector prevention platform. That is why the country was able to withstand the US government funding cuts and also easily pivot from oral PREP to offering lenacapavir as an additional prevention option,” he said.
The government will fund the initial rollout of lenacapavir with part of a grant from the Global Fund to Fight Aids, TB and Malaria. The first batch of the medicine, which comprised 37,920 doses, arrived in South Africa in early April, but the health department has yet to announce a launch date for the programme.
Mohale said the start date will be finalised after the department has received the results of post-importation testing, a regulatory requirement for all imported medicines. The results are expected in mid to late May.
The programme aims to start about 229,360 patients on lenacapavir in the first year. It will prioritise health districts and populations with a high incidence of HIV, including adolescents and young women, and pregnant and postpartum women, he said.
• This article has been updated with new information.
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