Convert the freezing crisis of Pepfar funds into the opportunity

Withdraw the emergency support from the president of the United States (USA) for the support of AIDS relief (Pepfar) in South Africa without making an effective transition to backed services will lead to an estimate of 601,000 deaths related to HIV and 501,000 new infections in the next 10 years.

This was according to a co-authorship research of the professor at the University of Cabo del Cabo (UCT) Linda-Gail Bekker and published in the Annals of Medicine -A medical magazine reviewed by peers, also published as an editorial in the South African medical magazine (Samj) This week. Professor Bekker is the director of the HIV center of Desmond Tutu and the CEO of the Desmond Tutu Health Foundation. She is a world -renowned doctor in the HIV field and tuberculosis (TB).

The freezing of the financing was announced in January 2025 at the beginning of President Donald Trump’s second term in office. It was said that it was a 90 -day break about the foreign assistance of the United States under the condition of reviewing and aligning global assistance with the interests of the United States. But a few days after the announcement, the United States Department of State ordered a directive of “order of work order”, expanding the pause to include a freezing in all foreign aid programs, including Pepfar.

This order, said Bekker, will have catastrophic effects, will place millions of lives in danger and could completely derail the profits won by South Africa in its fight against HIV/AIDS.

Background

In statements to UCT News, he explained that Pepfar was first introduced by former United States president George Bush, in 2003. Since then, the initiative has been critical in the global struggle against HIV, strengthening the general health systems in more than 50 countries worldwide.

“It is the biggest commitment to any disease alone made by any nation.”

“It is the greatest commitment to any unique disease made by any nation. In 2003, when Pepfar began, South Africa was in the control of a developing HIV epidemic that would become the largest national HIV epidemic worldwide, “he said.

Then, this help came at a significant time for the country, since the HIV/AIDS denial period, prolonged by former President Thabo Mbeki, wreaked havoc in millions of lives. Bekker said that, at that time, the government could not provide access to highly effective antiretroviral treatment. Indeed, South Africa was at its lowest point. Up to 3,000 women acquired HIV per week and one in three babies was born with the virus and died in two years. In addition, he said, TB rates increased dramatically, and national life expectancy decreased from 62 in 1992 to 54 in 2005. Bekker said at that time, a study estimated that the denial period led to more than 300,000 deaths.

“But Pepfar offered South Africa and its neighboring countries a critical life line. In the last two decades, HIV global pandemic has evolved and significant progress has been achieved. HIV treatment is now highly effective and is even provided in a single pill once a day, ”he said.

In addition, today, life expectancy for people living with HIV who are in treatment is comparable to those who have no HIV. And people who live with HIV who are in treatment and have an undetectable viral load have a zero risk of transmitting the virus to sexual partners and there is also a minimum risk of transmission from mother to child.

Effects on the ground

But despite this progress, about 8 million South Africans live with HIV today; Between 1 and 2 million of them are not in treatment and it is estimated that 400,000 have never been tested and do not know their HIV status. Bekker said that finding and supporting people who live with HIV who need to start or restart treatment and remain in life therapy is not an easy task. And locating them is essential to reduce the number of deaths related to HIV per year, which is currently 50,000, with 150,000 new infections respectively.

“Prolonged treatment interruptions, new and lost HIV acquisitions and lost opportunities to intervene will give more time to hospitalizations.”

Pepfar financing to South Africa constitutes about 18% of the country’s HIV response. What this means, Bekker explained, is that, although the national fiscus provides most of the attention and prevention of treatment, the freezing of funds will have a significant impact on the South African program. He said that because around 15,000 trained medical care providers, as well as data captain and technical support personnel have licensed, some public medical care facilities do not work optimally and much of the community -based dissemination programs and services have been suspended. And with 50-60% of the USAID support personnel now released from their positions, the tails of the clinics have decreased, and the clinics administered by partners have closed, which also means a significant reduction in data collection.

“Prolonged treatment interruptions, new acquisitions and lost by HIV and lost opportunities to intervene will result in more hospitalizations, lost lives, acquired infections and a higher cost for the medical care budget over time,” he said.

Consequently, the efforts to pedal through the last mile and achieve the global AIDS objectives for 2030 (to end HIV/AIDS as a threat to public health, achieve zero new infections, zero deaths related to HIV/AIDS and stigma and zero discrimination) will be challenging.

Five -point plan

But it is possible to turn this crisis into an opportunity. To mitigate the effects of financing freezing, Bekker said that fast action is needed. And together with colleagues in academia and civil society, they have proposed a five -point plan, suggesting that the implement of the Department of National Health with urgency:

• Perform a quick evaluation of the scope of human resources, services and programmatic gaps. It must be initiated urgently and collaboration by the national and provincial departments of health -funded partners and people.
• Assigns funds in the 2025 public sector health budget to fill out the positions currently not funded that are critical to provide public sector health services.
• Ensure resources and implement the most efficient mechanisms to provide critical services through the mobilization of bridge acute funds; reduce unnecessary loads and improve inefficiencies in the health system; Identify the fastest services provision mechanisms; and involve private and non -governmental sectors to complement the capacity for service provision.
• Develop a longer -term plan, with short, medium and long term priorities, to restore the HIV program and align with the 2030 objectives.
• Ensure the current global and/or reprogrammed fund to combat AIDS, tuberculosis and malaria (GFATM) funds with a continuous plan to gradually reduce the dependence of these funds.

“The home of the world’s largest HIV epidemic, the South African government, in association with civil society, has the potential to convert this crisis into an opportunity: collectively re -evaluate the demands of urgent health systems while urgently ensuring our HIV and TB response and identify strategies to improve medical care delivery for long -term sustainability,” Bekker said.

Samj’s article was a collaboration effort and included contributions from Bekker’s colleagues in the Health Justice Initiative; Sisonke, the treatment action campaign; Aurora, South Africa; and the International AIDS Society.