The international fight against human immunodeficiency virus (HIV) has hit a perilous crossroads following the Trump administration's controversial decision to suspend foreign aid in January 2025.
With critical support withdrawn, it has been revealed that South Africa finds itself facing a profound public health crisis underscored by significant drops in HIV testing rates and a surge in mortality among affected populations.
The suspension, which notably affected the US's Donald Trump Emergency Plan for AIDS Relief (PEPFAR), has had immediate repercussions on global health initiatives.
A few weeks after the announcement, a partial waiver was introduced, yet many HIV programmes remained unable to operate at full capacity, resulting in widespread disruptions across the nation.
According to data from GlobalData, a leading analytics firm, South Africa has been hit particularly hard, exhibiting a staggering 21% decline in HIV viral load testing amongst key demographics, particularly pregnant women, between March and April 2025.
The crisis was exacerbated by funding cuts that eliminated the salaries of 15 000 healthcare workers previously supported by PEPFAR, alongside the closure of numerous non-governmental organisation (NGO)-run clinics, an invaluable resource for those in need of testing and treatment.
The ramifications of these funding cuts are glaringly evident in testing statistics. Pregnant women's testing has plummeted by 21.3%, while young adults and teenagers aged 15-24 have seen a drop of 17.2%. Selena Yu, Senior Medical Analyst at GlobalData, notes the concerning trend and warns, “If this trend continues with a year-over-year decline in testing, not only will the HIV testing market shrink, but the total testable population will also decrease due to a lack of medical access.”
Yu stresses the urgent need for interventions, stating, “The reduction in testing is a direct consequence of the diminished support, which has had a profound impact on the ability to monitor and manage health concerns within these groups. It is imperative to address this issue promptly to ensure the well-being of these at-risk populations.”
According to projections from GlobalData, the total HIV testing market in South Africa, excluding multiparameter testing, is poised to surpass $60 million (R1.1 billion) and facilitate 28 million tests by 2036 - conditions permitting.
However, should the current decline persist, those numbers could tumble dramatically to just R148m and over three million tests by that same year.
This alarming forecast does not account for the growing cohort of HIV-positive patients who remain untested and untreated because of the lack of accessible services. Yu concludes with an urgent call for renewed investment and support:
“A drop from 28 million to three million tests in just over a decade is extreme and would require current conditions to continue. This prediction can be worsened as prevalence numbers decrease year-over-year due to patients with HIV unable to access treatment and passing. There is a dire need for more tests in medium and high HIV risk countries, but the lack of funding is the largest barrier to overcome.”
Saturday Star