SA Secures US HIV Funding Lifeline, Prepares for Game-Changer Drug Rollout

In a year marked by uncertainty and diplomatic tension, a lifeline has emerged for South Africa's fight against HIV/AIDS. Following the suspension of all foreign aid to South Africa by U.S. President Donald Trump in January 2025, the South African government scrambled to mitigate the fallout, particularly with regard to the country's heavily U.S.-funded HIV programme.

The suspension had immediate and devastating consequences. At the heart of the affected aid was the President's Emergency Plan for AIDS Relief (PEPFAR), a flagship U.S. initiative responsible for supporting HIV treatment and prevention programmes across Africa. South Africa, as one of the world's most HIV-affected nations, had relied on more than $400 million annually from PEPFAR. The funding freeze led to staff retrenchments, service delivery breakdowns, and a looming public health crisis.

Diplomatic Tensions Spark Health Sector Crisis

The aid suspension occurred in the context of escalating diplomatic tensions between South Africa and the United States. Despite this strained environment, South African authorities saw an opportunity to engage constructively, working towards a resolution that would serve both nations' interests and maintain life-saving services for millions.

Negotiations proved fruitful. On 1 October 2025, the United States announced a $115 million bridging plan to support South Africa's HIV programme for a further six months, until March 2026. This decision has been widely welcomed as a sign of stabilising diplomatic relations and a shared commitment to public health.

Minister in the Presidency, Khumbudzo Ntshavheni, hailed the announcement during a post-Cabinet briefing on 16 October 2025. "It's a confirmation of the good bilateral relations between South Africa and the U.S. so that when we have complaints, they intervene and we find an amicable solution to the problem," she said.

New Weapon in the HIV Arsenal: Lenacapavir

The timing of the renewed support is pivotal. South Africa is preparing to roll out Lenacapavir, a groundbreaking long-acting antiretroviral treatment, as early as March or April 2026. Delivered via injection just twice a year, Lenacapavir promises to revolutionise HIV prevention and treatment by dramatically improving adherence, which remains a persistent challenge with existing daily oral regimens and bi-monthly injectables.

Unlike conventional therapies requiring continuous patient discipline, Lenacapavir's six-month efficacy window after a single injection offers both medical efficiency and lifestyle convenience.

Clinical trials have yielded exceptional results:

• Among women in one trial, Lenacapavir showed 100% efficacy during the study period.

• In another trial involving men who have sex with men and transgender women, it demonstrated approximately 96% efficacy.

Burden Still High, But Future Looks Brighter

Despite being a global leader in HIV treatment, South Africa still bears the heaviest burden of the epidemic. With an estimated 8 million people living with HIV, the need for innovation and sustained investment remains critical. In 2023 alone, approximately 149,000 new HIV infections were recorded in the country.

Worryingly, adolescent girls and young women remain disproportionately affected, alongside other key populations. Factors such as low condom use and inconsistent adherence to oral pre-exposure prophylaxis (PrEP) have been identified as key contributors to the sustained infection rates.

Over 2 million South Africans have been initiated on oral PrEP to date. This is complemented by a comprehensive prevention approach that includes:

• HIV testing and counselling

• Condom distribution

• Medical male circumcision

• Behavioural change campaigns

• Education and community mobilisation

However, adherence continues to be the Achilles' heel of these programmes—one that Lenacapavir may finally help resolve.

Modelling Shows Pathway to Epidemic Control

Mathematical modelling suggests that if between 2 and 4 million people begin using Lenacapavir over the next two years, South Africa could reduce new HIV infections to below 0.1% by 2032. That would represent a decade's head start on the country's existing epidemic control timeline.

This development offers a renewed vision of hope—a future where HIV is no longer a public health threat. South Africa could finally edge closer to achieving the goal of an AIDS-free generation by 2030.

A Partnership Still Vital

Though tensions remain between Pretoria and Washington, the recent funding reprieve suggests that cooperation in the health sector can transcend political disputes. PEPFAR's continued support is not just an investment in South Africa's health system—it is a demonstration of global solidarity in the face of one of humanity's most enduring health challenges.

As South Africa prepares for the rollout of Lenacapavir, the world will be watching to see whether this bold new approach can help turn the tide of the HIV epidemic. For millions of South Africans, it represents more than just a new treatment option—it symbolizes renewed hope.