A 19-year-old unemployed woman, Nozuko Majola, from a rural village in South Africa’s KwaZulu-Natal province, is uncertain whether she can afford the one-hour trip to collect her crucial HIV medication.
The rough, untarred roads in her area often prevent timely delivery to her home.
“Things will be tough around here, and a lot of people will default on their treatment because we really struggle with transport,” she said. “The mobile clinics hardly come here.”
Majola’s situation reflects the wider impact of the U.S. foreign aid freeze imposed under former President Trump. This suspension has raised alarm over potential rises in HIV cases and fatalities, as many patients are now unable to access the vital treatment they need.
A 2024 report from the Human Sciences Research Council revealed that KwaZulu-Natal has the second-highest HIV rate in South Africa, with an estimated 1,300 new infections among young people each week.
The province also has the highest number of people living with HIV—approximately 1.9 million—contributing to South Africa’s position as the country with the most HIV-positive individuals in the world, totaling over 7.5 million.
In total, 5.5 million South Africans depend on antiretroviral medication, partially funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). However, the suspension of this crucial aid threatens the future of these treatment programs.
PEPFAR’s funding, which amounts to over $400 million annually, accounts for about 17% of South Africa’s HIV-related expenses, according to the Health Ministry. Since its launch in 2003, PEPFAR has been instrumental in saving over 26 million lives globally.
“People who were doing administration and data capturing, whose salaries were funded by PEPFAR, have left. We are a small facility and we cannot handle such a workload,” said the manager, who spoke on condition of anonymity because they were not authorized to speak to the press.
A recent federal ruling temporarily lifted the freeze on funding, allowing some PEPFAR projects to resume, but many organizations have already been forced to close, adding pressure on already overburdened public health facilities.
Much of PEPFAR’s funding goes to non-governmental organizations that support the government’s HIV response, particularly in rural areas like Umzimkhulu, where unemployment is widespread and access to healthcare is limited.
With the aid freeze, these services have been significantly disrupted, leaving communities like Majola’s without vital support.
Nozuko Ngcaweni has been receiving HIV treatment for nearly three decades. Tragically, one of her children also contracted the virus and passed away at the age of 17. She shared how the suspension of aid has already taken a toll on her community, with many individuals missing out on their crucial medication.
“Not long ago, we said by 2030, we want to see an HIV-free generation. But if things remain as is, we will not achieve that. We will have to deal with deaths,” she said.
A provincial manager for the Treatment Action Campaign, Mzamo Zondi, which fights for access to HIV care for the impoverished, has been closely tracking the effects of the aid freeze in Umgungudlovu.
“Our response (to HIV) is likely to falter as we struggle to stop newly infected cases,” he said. “This is a matter of life and death.”