South Africa’s HIV fight at risk after $427M US aid cut

South Africa's government has vowed it won't let the US withdrawal of about $427 million in support collapse its HIV program - the largest in the world - but it is struggling to fill the gap and experts are warning the next few years could see hundreds of thousands of new infections.

South Africa has more people living with HIV than any other country in the world. When US President Donald Trump slashed America’s foreign aid budget, the impact was immediate, as free clinics closed their doors, leaving patients without medication.   

"Our lives matter, we are human," says one woman who chose to remain anonymous. She's a sex worker and depended on one of the clinics for treatment.

"The funding played a significant role in our lives. The clinic would come to my apartment, give me services there. They would come test me in my home every 3 months, give me my refill. I would only go to the clinic for my prescription. Whenever I needed condoms or lubricant, the clinic was there to give me." 

Patients say they’ve been turned away from public hospitals, even though authorities insist that shouldn’t be happening.  

Others say they’ve been forced to buy HIV medication on the black market, where pills have nearly double in price. 

'We are scared'

The government has vowed it won't let the US withdrawal of more than $400 million in support collapse its HIV program - but it's struggling.

Yvette Raphael is co-founder of the local Advocacy for Prevention of HIV and AIDS group. She says she's scared the country will go backwards:

"We are scared. We are scared that we are going to see high numbers of people living with HIV rising. We are scared that we are going to see people dying again. We are worried about the number of infants that are going to be born with HIV because of the lack of services. What the reality is, the funds that we used to get from USAid was covering a gap that our government couldn't fix." 

More than 63,000 people depended on the 12 clinics across the nation that shut down. Up to 220,000 people have faced disruption to their daily HIV medication. Even before the cuts, of the country's estimated 8 million people living with HIV, only 2 million were on medication.

The concerns echo across Africa, the continent hardest hit by the US aid cuts. The Trump administration has defended the cuts, saying the spending was not aligned with US interests.

“And we’re $37 trillion in debt. So at some point, the continent of Africa needs to absorb more of the burden of providing this health care,” Russell Vought, director of the US Office of Management and Budget, told a hearing in June.

Among South Africans, some wonder whether Trump’s stance may have been influenced by their countryman Elon Musk, who oversaw the early efforts to cut US aid.

“I’ve got no civil words to express how I feel, but I just hate them for what they did,” one transgender woman said. "Our lives matter.”

The US has issued a limited waiver allowing some vital HIV services to resume, but the cuts in aid have created chaos. And for many of those affected, the damage is already done.