HIV testing and monitoring across South Africa have dropped significantly following major cuts in U.S. aid, according to unpublished government data, raising alarm among health experts about the impact on vulnerable populations, particularly pregnant women, infants, and youth.
South Africa has the world’s largest HIV burden, with about 8 million people, one in five adults living with the virus. Until earlier this year, the United States funded 17% of the country’s HIV response through its global initiative, the President’s Emergency Plan for AIDS Relief (PEPFAR). However, that support was slashed under former President Donald Trump’s administration.
Data from the National Health Laboratory Service shows that viral load testing, critical for monitoring patients on antiretroviral therapy, declined sharply in March and April. Testing among young people aged 15–24 fell by 17.2% in April compared to the same month last year, while maternal viral load testing dropped 2by 1.3%. Early infant diagnostic testing declined nearly 20% over the same period.
“These are shocking figures, with profound implications for maternal and child health,” said Francois Venter, executive director of the Ezintsha Research Centre in Johannesburg.
Viral load tests measure the amount of HIV in a patient’s blood and are vital to determine whether treatment is working and whether the virus is suppressed to levels that prevent transmission. Fewer tests can mean missed cases, treatment interruptions, and increased transmission risk.
Experts link the drop in testing directly to the withdrawal of U.S. funding, which previously paid the salaries of roughly 15,000 health workers. These workers conducted HIV testing and counseling, traced patients who missed appointments, and supported high-risk groups like sex workers and LGBTQ+ individuals.
In the absence of U.S. support, many NGO-run clinics have shut down. Patients are being redirected to public health centers, which are often overcrowded and under-resourced. Health workers report that some clinics are now too understaffed to offer basic services like blood draws for viral load testing or to enroll pregnant women in preventive HIV treatment programs such as PrEP.
“This data demonstrates what previous models have shown that the cuts are hurting pregnant women and infants most,” said Dvora Joseph Davey, an epidemiologist at the University of Cape Town. She added that clinics in Cape Town are visibly struggling, with fewer nurses and longer delays in patient care.
The decline in testing also correlates with a nationwide drop in viral suppression rates, down 3.4% in March and 0.2% in April, further suggesting treatment disruptions.
In Diepsloot, a Johannesburg township, community HIV activist Sophy Moatshe said the situation is dire. “People don’t want to go to the clinic because of stigma. If no one checks on them, they’re going to die,” she said.
Although South Africa never relied on U.S. aid for its HIV medication supply, the loss of support staff has severely hampered patient outreach and follow-up, essential components of the country’s prevention and treatment strategy.
The U.S. State Department has not commented on the funding cuts. South Africa’s Department of Health acknowledged the challenges, with spokesperson Foster Mohale saying the government is exploring alternative funding sources but declined to provide further details.
Experts warn that the current trends may foreshadow a resurgence in new HIV cases and deaths if testing and support systems are not restored. “The April data is a clear indication of what’s to come,” said Davey.
