Impact of Pepfar-funding withdrawal: Voices from three SA organisations on-the-ground

While the withdrawal of the US President’s Emergency Plan for Aids Relief (Pepfar) funding has been dominating headlines, some of the finer details, such as the actual impact on affected organisations has not been reported on as extensively.

One organisation who has been with the programme for more than 10 years, has shared insight into how devastating the sudden withdrawal of funding has been for them.

The Networking HIV and AIDS Community of Southern Africa (NACOSA) said that the impact of the actions by United States President Donald Trump would not only set them back, but also set back other organisations across the world.

Pepfar-funded HIV organisations who receive grants from the United States Agency for International Development, USAID, received letters in the beginning of February alerting them that their grants have been terminated.

Since Pepfar’s inception in 2003, the US government has invested over $100 billion in the global HIV/AIDS response, saving over 25 million lives, preventing millions of HIV infections, and supporting several countries to achieve HIV epidemic control, all while significantly strengthening global health and economic security.

NACOSA spokesperson, Sophie Hobbs, said that they have been a Pepfar implementing partner since 2014, focusing on orphaned and vulnerable children and youth and community-based violence and HIV prevention and response.

Hobbs explained that although Pepfar funded only 17% of South Africa’s HIV and GBV response, a significant amount of this funding is provided directly to independent, non-profit South African organisations.

“The concern is that it is the community response that will be lost in this crisis… This has been a large-scale and highly-effective programme.

“We served an average of 100 000 adolescent girls and young women annually with prevention services, 32 000 survivors of violence in 100 post-violence care facilities country-wide, 5 200 children living with HIV and 15 000 other vulnerable children and households,” Hobbs said.

Hobbs explained that NACOSA works with 15 implementing organisations that are currently not receiving funding to deliver services to vulnerable children and care facilities.

“At least one organisation receives 100% of their funding from the programme with others ranging from 10% to 54% of their funding. Six hundred and twenty (620) staff working at implementing partner organisations as part of this programme have been withdrawn from the field and have been laid off,” Hobbs said. “A total of 155 NACOSA staff have lost their jobs.”

The impact on communities is something that the Treatment Action Campaign (TAC) has also seen.

TAC spokesperson Xabisa Qwabe said that healthcare workers funded through Pepfar have already been pulled from clinics, “leading to service disruptions and longer wait times".

“Drop-in centers for key populations are closing, making it harder for vulnerable groups to access treatment. The retention crisis is worsening, with more people struggling to stay on lifesaving ARVs. TAC’s ability to monitor and advocate for better healthcare is also at risk without urgent funding,” Qwabe said.

“Many organisations, including TAC, are now in urgent fundraising mode, seeking alternative funding to continue essential services. Advocacy efforts are ramping up, both locally and internationally, to pressure the U.S. government to reinstate funding.

“Meanwhile, affected groups must find ways to minimise harm, such as prioritising the most critical services and mobilising communities to demand action,” Qwabe said.

Hobbs echoed Qwabe’s remarks, stating that the scale of job losses and service disruptions is significant.

“Our work focuses on community-based services supporting health facilities. Without community care and linkage workers to mobilise people and facilitate access, backlogs form at facilities.

“Vulnerable people and children who access community based services from mobile units and safe spaces are forced to go to facilities, exacerbating backlogs. Many will stop accessing services. There are also a number of ancillary organisations and services that are involved with the delivery of these programmes such as catering suppliers, trainers etc,” Hobbs said.

She added that similarly to the Covid pandemic, the disruption of services and economic hardship related to job losses, is very likely to cause:

• A spike in violence against women and children, without access to the post-violence care support our programme provided.
• An increase in new HIV infections due to the termination of community prevention efforts.
• A reduction in adherence to antiretroviral medication, PrEP and PEP (post-exposure prophylaxis). Community services play a critical role in helping people to access health services.
• An increase in AIDS-related deaths and femicide.
• The permanent shuttering of community-based health and social services.

The Triangle Project’s spokesperson, Ling Sheperd, shared that this also has affected their ability to provide essential support services, particularly for LGBTQIA+ communities.

“For the people who rely on these services, the impact is immediate and devastating. Reduced access to HIV prevention and treatment services means an increased risk of transmission, poorer health outcomes, and greater strain on already vulnerable individuals. For many, particularly strategically undervalued communities, LGBTQIA+ people, community-led services are their only option for safe and non-discriminatory healthcare,” Shepherd said.

“Unlike academic institutions that may have the flexibility to reallocate resources, organisations like Triangle Project work directly with communities where funding gaps cannot simply be absorbed or adjusted for. The impact here is tangible, without financial support, services disappear, leaving people without care.”

Hobbs added: “The hardest thing for us has been the suddenness of the termination of our grant, which makes up 40% of our funding, and the uncertainty surrounding when or if that funding will return.

“South Africa has made incredible progress in achieving UNAIDS targets, reducing mother-to-child HIV transmission, and increasing life expectancy. PEFPAR has been a highly successful, cost-effective programme that has saved millions of lives.

“With new developments like long-acting injectable PrEP, we were hopeful that we had the end of AIDS within our sights. The funding disruption will set us back considerably – not just in South Africa but across the world.”

Qwabe added that without urgent intervention, there will be rising transmission rates, more preventable deaths, and a collapsing public healthcare system.

“The global community must act now to protect these lifesaving programs before the damage becomes irreversible.”

Hobbs said: “Without this critical support, thousands of health, community and social care workers will lose their jobs, and a significant number of people—including children—will be unable to access lifesaving treatment.

“HIV testing, treatment, and prevention efforts will slow down, leading to higher infection rates, more drug-resistant TB cases, and increased mortality. Adolescent girls and young women will have reduced access to HIV and violence prevention and care services, making them increasingly more vulnerable to HIV,” Hobbs said.

“Young women are twice as likely as young men to acquire HIV in South Africa. Critical services to survivors of sexual violence are disrupted, including support to access HIV testing, post-exposure prophylaxis, trauma containment, linkage to treatment, child protection and other social services. About 90% of violence cases are women and about 43% are under the age of 18.

“Community-health care workers are sitting at home which is not only a loss of income for them (many of them are breadwinners), they are also passionate and dedicated people who are now not able to do the vital community work they were doing before,” said Hobbs. 

Shepherd added that LGBTQIA+ communities have historically been underfunded and underserved in HIV response strategies, and this decision further exacerbates inequalities.

“There needs to be a more sustainable funding model that prioritises the voices and needs of those most affected.”

In a small victory for organisations, late on Wednesday evening, it was announced that a divided United States Supreme Court rejected the Trump’s administration’s request to keep Pepfar funding frozen. However, the court did not mention when the money would be released, leaving the matter in limbo.

theolin.tembo@inl.co.za