In a remote village in South Africa’s KwaZulu-Natal province, 19-year-old Nozuko Majola worries about affording the hour-long trip to collect her essential HIV medication, usually delivered to her inaccessible home via untarred roads.
Majola is among millions of South Africans impacted by U.S. President Donald Trump’s freeze on foreign aid, sparking fears of widespread treatment interruptions, rising infection rates, and increased fatalities.
A 2024 report from the Human Sciences Research Council revealed KwaZulu-Natal had the country's second-highest HIV prevalence at 16%, with around 1,300 new infections weekly among young people. In 2022, the province recorded the highest number of HIV-positive individuals — approximately 1.9 million — contributing to South Africa’s total of over 7.5 million cases, the highest globally.
Trump’s suspension of the President’s Emergency Plan for AIDS Relief (PEPFAR), which annually provides over $400 million (17% of South Africa’s HIV funding), has placed the treatment of 5.5 million South Africans on antiretroviral therapy at risk. Since its inception in 2003, PEPFAR has saved at least 26 million lives worldwide, according to the U.N. AIDS agency.
A federal judge recently ordered a temporary lift on the freeze, and the U.S. Embassy in South Africa announced the resumption of PEPFAR projects under a limited waiver. However, several HIV-focused NGOs have already shut down, leaving patients to seek care at overwhelmed public clinics, while PEPFAR-funded vehicles sit idle.
NGOs, which supplement government healthcare services, have been crucial for patients like Majola in Umzimkhulu, where high unemployment forces many to depend on subsistence farming and welfare. Majola expressed concern that many patients would miss their treatment due to transport challenges and infrequent mobile clinic visits.
The funding halt has also displaced nearly 15,000 PEPFAR-funded health workers, adding strain to the healthcare system. In Umgungundlovu, the district with the country’s highest HIV cases, counselors and clinic managers are struggling with administrative burdens left by departing PEPFAR staff.
Long-time HIV patient Nozuko Ngcaweni, who lost a child to the virus, lamented the impact of the aid suspension, fearing it threatens the goal of an HIV-free generation by 2030. Mzamo Zondi, provincial manager of the Treatment Action Campaign, warned that the aid freeze jeopardizes efforts to curb new infections, calling it “a matter of life and death.”