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How Much does Our HIV Response Depend on US Funding?

On By ModernMedia
The United States has slashed its HIV funding — through the PEPFAR programme — to African countries. Archive photo: Ashraf Hendricks

By Jesse Copelyn

After the US slashed global aid, the South African government stated that only 17% of its HIV spending relied on US funding. But some experts argue that US health initiatives had more bang for buck than the government’s programmes. Jesse Copelyn looks past the 17% figure, and considers how the health system is being affected by the loss of US money.

In the wake of US funding cuts for global aid, numerous donor-funded health facilities in South Africa have shut down and government clinics have lost thousands of staff members paid for by US-funded organisations. This includes nurses, social workers, clinical associates and HIV counsellors.

Spotlight and GroundUp have obtained documents from a presentation by the National Health Department during a private meeting with PEPFAR in September. The documents show that in 2024, the US funded nearly half of all HIV counsellors working in South Africa’s public primary healthcare system. The data excludes the Northern Cape.

Counsellors test people for HIV and provide information and support to those who test positive. They also follow up with patients who have stopped taking their antiretrovirals (ARVs), so that they can get them back on treatment.

Overall, the US funded 1,931 counselors across the country, the documents show. Now that many of them have been laid off, researchers say the country will test fewer people, meaning that we’ll miss new HIV infections. It also means we’ll see more treatment interruptions, and thus more deaths.

PEPFAR also funded nearly half of all data capturers, according to the documents. This amounted to 2,669 people. Data capturers play an essential role managing and recording patient files. With many of these staff retrenched, researchers say our ability to monitor the national HIV response has been compromised.

These staff members had all been funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR). The funds were distributed to large South African non-government organisations (NGOs), who then hired and deployed the staff in government clinics where there is a high HIV burden. Some NGOs received PEPFAR funds to operate independent health facilities that served high-risk populations, like sex workers and LGBTQ people.

But in late January, the US paused almost all international aid funding pending a review. PEPFAR funds administered by the US Centres for Disease Control (CDC) have since resumed, but those managed by the US Agency for International Development (USAID) have largely been terminated. As a result, many of these staff have lost their jobs.

The national health department has tried to reassure the public that the country’s HIV response is mostly funded by the government, with 17% funded by PEPFAR – currently about R7.5 billion a year. But this statistic glosses over several details and obscures the full impact of the USAID cuts.

Issue 1: Some districts were heavily dependent on US funds

The first issue is that US support isn’t evenly distributed across the country. Instead, PEPFAR funding is targeted at 27 ‘high-burden districts’ – in these areas, the programme almost certainly accounted for much more than 17% of HIV spending. Some of these districts get their PEPFAR funds from the CDC, and have been less affected, but others got them exclusively from USAID. In these areas, the HIV response was heavily dependent on USAID-funded staff, all of whom disappeared overnight.

Johannesburg is one such district. A doctor at a large public hospital in this city told Spotlight and GroundUp that USAID covered a substantial proportion of the doctors, counsellors, clerks, and other administrative personnel in the hospital’s HIV clinic. “All have either had their contracts terminated or are in the process of doing so.”

The hospital’s HIV clinic lost eight counselors, eight data capturers, a clinical manager, and a medical officer (a non-specialised doctor). He said that this represented half of the clinic’s doctors and counselors, and about 80% of the data capturers.

This had been particularly devastating because it was so abrupt, he said. An instruction by the US government in late-January required all grantees to stop their work immediately.

“There was no warning about this, had we had time, we could have made contingency plans and things wouldn’t be so bad,” he explained. “But if it happens literally overnight, it’s extremely unfair on the patients and remaining staff. The loss of capacity is significant.”

He said that nurses have started to take on some of the tasks that were previously performed by counselors, such as HIV testing. But these services haven’t recovered fully and things were still “chaotic”.

He added, “It’s not as if the department has any excess capacity, so [when] nurses are diverted to do the testing and counselling, then other parts of care suffer.”

Issue 2: PEPFAR programmes got bang for buck

Secondly, while PEPFAR may only have contributed 17% of the country’s total HIV spend, some researchers believe that it achieved more per dollar than many of the health department’s programmes.

Professor Francois Venter, who runs the Ezintsha research centre at WITS university, argued that PEPFAR programmes were comparatively efficient because they were run by NGOs that needed to compete for US funding.

“PEPFAR is a monster to work for,” said Venter, who has previously worked for PEPFAR-funded groups. “They put targets in front of these organisations and say: ‘if you don’t meet them in the next month, we’ll just give the money to your competitors’ and you’ll be out on the streets … So there’s no messing around.”

US funding agencies, he said, would closely monitor progress to see if organisations were meeting these targets.

“You don’t see that with the rest of the health system, which just bumbles along with no real metrics,” said Venter.

“The health system in South Africa, like most health systems, is not terribly well monitored or well directed. When you look at what you get with every single health dollar spent on the PEPFAR program, it’s incredibly good value for money,” he said.

Not only were the programmes arguably well managed, but PEPFAR funds were also strategically targeted. Public health specialist Lynne Wilkinson provided the example of the differentiated service delivery programme. This is run by the health department, but supported by PEPFAR in one key way.

Wilkinson explained that once patients are clinically stable and virally suppressed they don’t need to pick up their ARVs from a health facility each month as it’s too time-consuming both for them and the facility. As a result, the health department created a system of “differentiated service delivery”, in which patients instead pick up their medication from external sites (like pharmacies) without going through a clinical evaluation each time. But Wilkinson noted that before someone can be enrolled in that service delivery model, clinicians need to check that patients are eligible.

“Because [the enrollment process] was going very slowly … this was supplemented by PEPFAR-funded clinicians who would go into a clinic and review a lot of clients, and get them into that system”. By doing this, PEPFAR-funded staff successfully resolved a major bottleneck in the system, she said, reducing the number of people in clinics, and thus cutting down on waiting times.

Not everyone is as confident about the overall PEPFAR model. The former deputy director of the national health department, Dr Yogan Pillay, told Spotlight and GroundUp that we don’t have data on how efficient PEPFAR programmes are at the national level. This needs to be investigated before the health department spends its limited resources on trying to revive or replicate the programmes, argued Pillay who is now the director for HIV and TB delivery at the Gates Foundation.

While he said that many PEPFAR-funded initiatives were providing crucial services, Pillay also argued that “the management structure of the [recipient] NGOs is too top-heavy and too expensive” for the government to fund. Ultimately, we need to consider and evaluate a variety of HIV delivery models instead of rushing to replicate the PEPFAR ones, he said.

Issue 3: PEPFAR supported groups that the government doesn’t reach

An additional issue obscured by the 17% figure is that PEPFAR specifically targeted groups of people that are most likely to contract and transmit HIV, like people who inject drugs, sex workers, and the LGBTQ community. These groups, called key populations, require specialised services that the government struggles to provide.

Historically, PEPFAR has given NGOs money so that they could help key populations from drop-in centres and mobile clinics, or via outreach services. All of this operated outside of government clinics, because key populations often face stigma in these settings and are thus unwilling to go there.

For instance, while about 90% of surveyed sex workers say that staff at key populations centres are always friendly and professional, only a quarter feel the same way about staff at government clinics. This is according to a 2024 report, which also found that many key populations are mistreated and discriminated against at public health facilities. (Ironically, health system monitoring organisation Ritshidze, which conducted the survey, has been gutted by US funding cuts.)

While the key populations centres funded by the CDC are still operational, those funded by USAID have closed. The health department has urged patients that were relying on these services to go to government health facilities, but researchers argue that many simply won’t do this.

Venter explained: “For years, I ran the sex worker program [at WITS RHI, which was funded by PEPFAR] … Because sex workers don’t come to [health facilities], you had to provide outreach services at the brothels. This meant … we had to deal with violence issues, we had to deal with the brothel owners, and work out which days of the week, and hours of the day we could provide the care. Logistically, it’s much more complex than sitting on your bum and waiting for them to come and visit you at the clinic.

“So you can put up your hand and say: ‘Oh they can just come to the clinics’ – like the minister said. Well, then you won’t be treating any sex workers.” Venter said this would result in a public health disaster.

He argued that one of the most crucial services that key populations may lose access to is pre-exposure prophylaxis (PrEP), a daily pill that prevents HIV.

While the vast majority of government clinics have PrEP on hand, they often fail to inform people about it. For instance, a survey of people who are at high-risk of contracting HIV in KwaZulu-Natal found that only 15% were even aware that their clinic stocked PrEP.

Another large survey found that at government facilities, only 19% of sex workers had been offered PrEP. By contrast, at the drop-in centres for key populations, the figure was more than double this, at 40%. Without these centres, the health system may lose its ability to create demand for the drug among the most high-risk groups.

One health department official told Spotlight and GroundUp that the bulk of the PrEP rollout would continue despite the US funding cuts. “The majority of the PrEP is offered through the [government] clinics,” she said, 96% of which have the drug.

However, she conceded that specific high-risk groups like sex workers have primarily gotten PrEP from the key populations centres, rather than the clinics. “This is the biggest area where we are going to see a major decline in uptake for [PrEP] services,” she said.

600 000 dead without PEPFAR?

Overall, the USAID funding cuts have severely hindered the HIV testing programmes, data capturing services, PrEP roll-out, and follow-up services for people who interrupt ARV treatment. And the patients who are most affected by this are those that are most likely to further transmit the virus.

So what will the impacts be? According to one modelling study, recently published in the Annals of Medicine, the complete loss of all PEPFAR funds could lead to over 600 000 deaths in South Africa over the next decade.

While South Africa still retains some PEPFAR funding that comes from the CDC, beneficiaries are bracing for this to end. According to Wilkinson, the PEPFAR grants of most CDC-funded organisations end in September and future grants are uncertain. For some organisations, the money stops at the end of this month.

Meanwhile, if the government has any clear plan for how to manage the crisis, it’s certainly not making this public.

In response to our questions about whether the health department would be supporting key populations centres, the department’s spokesperson, Foster Mohale, said: “For now we urge all people living with HIV/AIDS and TB to continue with treatment at public health facilities.”

When pressed for details about the department’s plans for dealing with the US cuts, Mohale simply said that they could not reveal specifics at this stage and that “this is a work in progress”.

In his budget speech in Parliament on Wednesday, Finance Minister Enoch Godongwana did not announce any funding to cover the gap left by the abrupt end of US support for the country’s HIV response. Prior to the speech, Godongwana told reporters in a briefing that the Department of Health would assist with some of the shortfall, but no further information could be provided.

Published by GroundUp and Spotlight.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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It is a Time for Solutions, Says Prof Tulio de Oliveira in Face of US Funding Cuts

On By ModernMedia
Professor Tulio de Oliveira. (Photo: Supplied)

By Biénne Huisman

Cuts to United States spending on aid and medical research have caused widespread havoc and anxiety in the last month. Professor Tulio de Oliveira sat down with Spotlight’s Biénne Huisman to talk through what it might mean for health research in South Africa.

As the Trump administration moves to freeze foreign aid, halting vital humanitarian health programmes and medical research trials worldwide – leaving patients cut off from lifesaving medicines and scientists in a bind – Professor Tulio de Oliveira argues that the United States stand to lose far more from this move than its 1% government investment in foreign aid.

The non-partisan Pew Research Center recently released figures showing that of the American government’s total 2023 budget, 1.2% or about $71.9 billion was spent on foreign aid. Of this foreign aid budget, 14.7% or about $10.6 billion was earmarked for the “ongoing battle against HIV/AIDS” and 2% or about $1.5 billion for “combatting pandemic influenza and other emerging public health threats”.

Speaking to Spotlight in a boardroom at the Centre for Epidemic Response and Innovation (CERI) at Stellenbosch University, De Oliveira says: “Spending on biosecurity is an investment in the future – I think the United States benefits much more from our research and our work than what we cost them.” Biosecurity refers to measures designed to protect populations against harmful biological or biochemical substances.

During the height of the COVID-19 pandemic, De Oliveira, a professor in bioinformatics, shot to global attention for leading the South African team credited with discovering the Beta and Omicron variants of SARS-CoV-2. Now, in the face of a new global health upheaval, he insists that cross-border scientific collaboration is critical for combating the global spread of disease.

“Pathogens don’t need passports, they don’t care about nationality,” he says, referencing former World Health Organisation Director-General, Dr Margaret Chan, who first used the phrase at the 2007 World Health Assembly.

Professor Tulio de Oliveira. (Photo: Supplied)

De Oliveira is a native Brazilian who speaks accented English. During his interview with Spotlight, his demeanour is calm and his speech unrushed as he expands: “It’s of great interest to America to keep investing – not as a kind of donation, or because we’re entitled to it – but because of how it helps them. We just came out of a pandemic and America actually had much bigger waves of infection than many of the poor countries.”

He lists recent global population health threats: “Like with Covid, now we have influenza; and the virus is mutating, transmitting through multiple animals. We just had an outbreak of Marburg in Rwanda and another one in Kenya. We had an emergence of mpox in central Africa. We had an emergence in Sudan of a strain of Ebola. In Uganda, a growing rate of malaria drug resistance.

“And in the last year, the US saw the biggest number of TB cases ever. So it’s of critical interest that these pathogens get quickly identified, are quickly controlled, that you treat people so that it doesn’t spread to other countries. In the end, it’s the health of the global population, it doesn’t matter which country we live in or how wealthy people are.”

Major funding cuts

Scores of South African research groups (many who provide affiliated public healthcare services) have in the past received funding from United States government entities – including the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), USAID, and the President’s Emergency Plan for Aids Relief (PEPFAR).

Many of these funding flows have been paused in recent weeks by the Trump administration. As a result, several important clinical trials have been stopped. The impacts are far-reaching – around 28% of the South African Medical Research Council’s (SAMRC) 2025/2026 budget was set to be funded by US government entities. Professor Ntobeko Ntusi, President of the SAMRC, told Spotlight that it would be catastrophic if the funding is cut.

Adding further uncertainty, prominent vaccine sceptic Robert F. Kennedy has been confirmed as the US’s health secretary under the Trump administration. Kennedy has argued that the NIH should reduce its focus on infectious diseases and dedicate more resources to non-communicable diseases like diabetes. The US government has until now been by far the biggest funder of both HIV and TB research.

De Oliveira appears unflustered. At CERI, of which he is the founding director, he says only 7% of funding is from the NIH – “and we have reason to believe that the current NIH grants that we have will not be discontinued”. One such grant was for R40 million over five years awarded in 2023 to CERI’s Professor Frank Tanser for designing HIV prevention strategies.

In fact, De Oliveira says CERI and the KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP) which he also heads, are expanding. Both centres use state-of-the-art genomics – the study of the DNA of organisms – to identify new variants of pathogens and to prevent disease.

“Yes, the opposite, we’re in an expansion phase,” says De Oliveira.

“Just last week, we advertised five post-doctoral fellowship positions. We hope that we can even absorb some of the great talent that may be lost from groups that were unfortunately more reliant on American funding.”

He stresses the importance of having a diversified funding portfolio, saying the work of CERI and KRISP is funded through 46 active grants with another 9 in the offing. “We have multiple grants from multiple funders from multiple countries. So again, I know it’s easily said, but I think it’s something that we should learn going forward, not to grow too reliant on one funder.”

Filling the gap

If the United States pulls back permanently from its leadership role in providing global aid – and medical research funding in particular – who might fill the gap?

The New Yorker quotes Clemence Landers, vice-president of the think tank Centre for Global Development, suggesting that China might come forward.

In response, De Oliveira says: “China could fill the gap. But people don’t realise the biggest foundation in the world at the moment is called the Novo Nordisk Foundation in Denmark which is linked to the company that had the massive breakthrough with Ozempic. They could easily fill the gap if they wanted. There are others as well. I would not be surprised if a completely unexpected foundation came forward to fill the gap.”

Reflecting further, he expresses hope that “people with noble causes step up”.

In 2022, TIME Magazine named De Oliveira one of the world’s 100 most influential people, and in 2024 he cracked the magazine’s top 100 health list. Has this public recognition made it easier for him to attract funding? He shrugs this off.

“We’re really committed to having a global impact that saves lives. And that commitment is not centralised in the director, but in our vision shared across principal investigators. And this is really important for the sustainability of organisations. I get offered good jobs every couple of weeks, and I mean even though I don’t intend on going anywhere, anything could happen. For example, two weeks ago I was skateboarding and cracked my ribs.”

In a moment of levity, he elaborates: “And this is the fifth time I cracked my ribs. Once was while skateboarding, another while snowboarding, surfing, once while mountain biking and another time falling from a children’s tractor.”

De Oliveira moved to South Africa in 1997, as the AIDS crisis was heading toward its peak. He says he feels “eternally grateful” for the boost PEPFAR brought to South Africa’s HIV-programme, adding that today the country might be in a “better position to absorb the loss of the funding than say five, ten years ago”.

He notes that 17% of South Africa’s HIV/AIDS spending was from PEPFAR, but that this does not include the procurement of antiretrovirals. “So yes, I think as South Africans we might be in a position to come up with solutions, as the programme is very well run.”

De Oliveira’s concern is for more vulnerable African countries – he singles out Mozambique – which are reliant on foreign aid for the procurement of medicines like antiretrovirals.

Needless to say, these recent events are a setback in the quest to develop an HIV vaccine. “When you decrease investment in research and science, you keep further away from developing the solutions,” he says. “But in terms of HIV/AIDS, luckily there are antiretroviral therapies that are very efficient.”

As we wrap up the interview, De Oliveira zooms out to the bigger picture: “Unfortunately, we are destroying the environment, there’s increased globalisation and crazy urbanisation, and this is making it easier for infectious diseases to spread.

“This is a challenging time for scientific and medical research. A time to develop solutions.”

Republished from Spotlight under a Creative Commons licence.

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US Funding Remains Frozen for Many Life-saving Services

On By ModernMedia

Despite waivers, court judgments and assurances from the embassy, USAID funding for projects that provide HIV medication has not resumed

The Ivan Toms Centre for Health building in Green Point, Cape Town. Photo: Jesse Copelyn

By Jesse Copelyn

Numerous South African health projects funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR) remain closed. This is despite a federal court judgment which ordered President Donald Trump’s administration to lift the blanket freeze on global aid.

A waiver on life-saving humanitarian services appears to have had little effect. Funding remains frozen for many projects that provided services explicitly covered by the waiver, such as antiretroviral (ARV) medicines for people with HIV.

A spokesperson for one of these projects said that the United States Agency for International Development Aid (USAID) had not provided any communication regarding the waiver, despite requests for information.

A second organisation said USAID instructed it to provide an adapted budget that only covers services included in the waiver. The organisation submitted it, but it has not yet been approved. The organisation supports orphaned children living with HIV.

CDC funding

PEPFAR is a US initiative that provides billions of dollars a year toward combating HIV in different parts of the world. These funds are primarily distributed through two agencies: USAID and the Centers for Disease Control and Prevention (CDC).

In late January USAID issued stop-work orders to the organisations which it funds. A few days later, the CDC did the same. This was after an executive order by Trump which paused foreign development funding for 90 days pending a review. As a result, US-funded health organisations across South Africa were forced to close their doors. In some cases, HIV patients were left without ARVs.

Last week the CDC issued notifications to its recipient organisations rescinding the stop-work orders. The CDC stated that this was because of a temporary restraining order issued by a federal judge in Rhode Island that halted the Trump administration’s ability to freeze congressional funds. Since then, many South African organisations that get money from the CDC have reopened.

See also: How USAid freeze sent shockwaves through Ethiopia published in The Guardian

But USAID did not send out similar notifications. PEPFAR funds from this agency largely remain frozen.

In a separate judgment on 13 February, a federal judge in Washington DC blocked the implementation of Trump’s executive order to freeze foreign aid. The administration’s lawyers have argued that the US government can continue to freeze aid via other channels unrelated to the executive order.

Dangerous disruption

GroundUp and Spotlight visited three health centres in South Africa funded by USAID, and found all three remained closed. Representatives from a fourth USAID-funded organisation confirmed that its funding has not been restored, and that its partner organisation was in the same boat.

The first centre that we visited is a clinic in Rosebank, Johannesburg, run by OUT LGBT Wellbeing. It provided free HIV testing, ARVs, and the daily HIV-prevention pill (this is referred to as Pre-exposure Prophylaxis or PrEP). It’s one of several US-funded clinics that OUT operates around the country.

Its services are geared toward men who have sex with men. The reason is that rates of HIV are high among this group, and stigma may prevent some from seeking help in general healthcare settings.

When we visited the centre in Rosebank, a note was tied to the gate, stating: “Regrettably our clinic is temporarily closed and consequently no health services are available”. It encouraged patients to go to their nearest health facility.

According to OUT spokesperson Luiz De Barros, the clinics were forced to halt immediately after stop-work orders were issued. This prevented them from making alternative plans, leaving many people without ARVs or PrEP.

He said the centres had a total of 84 staff, who are now “at home without pay”, and about 5000 clients. Without their ARVs, De Barros worries that many clients are at risk of falling ill or developing drug-resistant HIV. Stopping HIV prevention services like PrEP will also “heighten the spread of HIV within communities,” he noted.

De Barros said they had not yet received any communication from USAID about the limited waiver, despite asking for information.

A clause in the waiver says it does not apply to “gender or DEI [diversity, equality and inclusion] ideology programs”. The Trump administration has not spelled out exactly what these terms mean, but it appears that DEI includes any health project which targets particular groups, like LGBTQ people.

GroundUp and Spotlight visited a second health centre in Hillbrow run by the WITS Reproductive Health Institute (RHI). A sign on the gate stated: “USAID has served the WITS RHI Key Populations Programme a notice to pause programme implementation. As of Tuesday, 28 January, we are unable to provide services until further notice.”

WITS RHI’s annual reports suggest that USAID has previously sponsored its projects to treat and prevent HIV, including among high-risk groups like sex workers and transgender people.

The third health facility that we visited is the Ivan Toms Centre for Health, based in Green Point, Cape Town. A temporary closure notification hung from the door. The centre provided HIV and TB testing, ARVs, PrEP, and counselling services – all focused on men who have sex with men.

Representatives from a fourth organisation, NACOSA, told GroundUp and Spotlight that it had been forced to halt all of its USAID-funded services. Subsequently, USAID instructed the organisation to provide a revised budget which only includes activities listed under the waiver. As part of this limited budget, NACOSA proposed retaining a project which helps orphaned and vulnerable children living with HIV in the Western Cape.

Dr Ntlotleng Mabena, a technical specialist at NACOSA, said the project provides these children with psychological support and connects them to health providers. Clinical workers linked to the ANOVA health institute (which is also US-funded) provide the children with ARV treatment, she said.

NACOSA submitted the revised budget with the hope of restarting this service, but they are still awaiting approval. Mabena stated that ANOVA was also waiting for permission to continue. In the meantime, the service remains closed.

The US embassy in South Africa maintains that Trump’s funding cuts do not affect PEPFAR initiatives that provide life-saving services as defined in the limited waiver.

Yet all of the life-saving PEPFAR services that we investigated on Thursday are closed. The only services which have reopened are those funded by the CDC, which is unrelated to the waiver.

Sign outside a Wits RHI clinic in Johannesburg. Photo: Ihsaan Haffejee

Published by GroundUp and Spotlight

Correction on 2025-02-21 12:29

Three paragraphs were removed from the article after publication because of confusion that arose as to whether they were on the record or not.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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SA Health Research Facing Catastrophic Financing Cuts

On By ModernMedia
Professor Ntobeko Ntusi is the president and CEO of the South African Medical Research Council. (Photo: SAMRC)

By Catherine Tomlinson

Cuts to United States funding of health research could have “catastrophic” consequences, says Professor Ntobeko Ntusi, who is at the helm of the country’s primary health research funder. He says the South African Medical Research Council is “heavily exposed” to the cuts, with around 28% of its budget coming from US federal agencies.

After an unprecedented two weeks of aid cuts by the United States government that left HIV programmes and research efforts across the world reeling, the Trump administration took the drastic step of freezing aid to South Africa in an executive order on 7 February.

The order – which is a directive to the executive branch of the US government and holds the weight of law – was issued to respond to what the White House called “egregious actions” by South Africa. It specifically points to the Expropriation Act and the country’s accusation of genocide against Israel at the International Court of Justice as the primary reasons for the funding freeze.

While there are some limited wavers and exceptions to the cuts, Spotlight understands that these have so far been poorly communicated and many HIV services remain in limbo.

The funding cuts, following an earlier executive order issued on 20 January,  are interrupting critical health research underway across South Africa and will ultimately undermine global efforts to stop HIV and TB.

The US is a major source of financing for health research in South Africa. Many of the country’s research institutes, groups, and universities receive funding from the US through the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), USAID, and the President’s Emergency Plan for Aids Relief (PEPFAR).

Over the past few weeks, these funding sources have come under siege by the Trump administration resulting in a gaping, and most likely insurmountable financing gap, for many health research endeavors in the country.

US spending accounts for just over half (55%) of all spending on global health research around the world. In 2022, the super power spent $5.4 billion on global health research, according to Impact Global Health –  an NPO that tracks health research spending.

While the US gives money to global health research through several different government departments and programmes, the largest source of funding for global health research is the NIH. The NIH contributed 65% of global financing for HIV research between 2007 and 2022, according to Impact Global Health and 34% of tuberculosis research financing in 2023, according to New York-based policy think tank, the Treatment Action Group.

South Africa has the biggest HIV epidemic in the world in absolute terms and is among the top 10 countries in terms of TB cases per capita.

Catastrophic consequences

“South Africa is the biggest recipient of NIH funding outside of the US”, Professor Ntobeko Ntusi, president and CEO of the South African Medical Research Council (SAMRC), told Spotlight. “[T]he consequences will be catastrophic if [funding] is stopped… for science that is important for the whole world,” he said.

South Africa plays a critical role in advancing HIV science, said Ntusi, adding that “many of the major trials that have advanced our understanding of both the effective strategies for HIV management, as well as understanding the mechanisms of disease emanated from South Africa”.

People in the US, for example, are now able to access long-acting HIV prevention shots, largely because of research that was conducted in South Africa and Uganda. Research conducted in South Africa has also been critical to validating new tuberculosis treatments that are currently the standard of care across the world.

Heavily exposed

Stop work orders were sent to research groups receiving USAID funding at the end of January. These stop work orders coupled with the halting of funding have already interrupted critical HIV research efforts, including efforts to develop new vaccines against HIV.

Ntusi said that the SAMRC is currently “heavily exposed” to the halting of grants from USAID and the CDC, with research programmes supported by USAID and the CDC already being stopped.

The SAMRC’s research on infectious diseases, gender-based violence, health systems strengthening, as well as disease burden monitoring are also affected by the funding cuts.

“In addition to support for HIV research, we have significant CDC grant funding in our burden of disease research unit, the research unit that publishes weekly statistics on morbidity and mortality in South Africa,” said Ntusi. “Our health systems research unit has a number of CDC grants which have been stopped [and] in our gender and health research unit we had a portfolio of CDC funding which also has been stopped.”

Along with programmes being impacted by the halting of USAID and CDC funding, Ntusi said there will also be major staffing ramifications at the SAMRC as well as at universities.

He said that if funding from the NIH is stopped “there would be huge fallout, we just wouldn’t be able to cover the hundreds of staff that are employed through the NIH granting process”.

The SAMRC’s combined annual income from US grants (NIH, CDC and USAID) is 28% of its total earnings (including both the disbursement from the SA government as well as all external contracts) for the 2025/2026 financial year, according to Ntusi. “So, this is substantial – effectively a third of our income is from US federal agencies,” he said.

Pivot away from infectious disease?

In addition to the executive order freezing funding to South Africa, it is unknown whether the NIH will remain a dominant funder of global health. Robert F. Kennedy Jr., the US health secretary nominee, has called for cutting to the NIH’s infectious disease research spending to focus more on chronic diseases.

Looking beyond health, Ntusi said the executive order halting aid to South Africa will be felt across a range of different development initiatives such as water and sanitation, and climate change.

Republished from Spotlight under a Creative Commons licence.

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Stopping Health Funding in Africa Weakens America

On By ModernMedia

This is an opportunity for President Ramaphosa to lead

Photo by Andy Feliciotti on Unsplash

By Nathan Geffen and Marcus Low

President Donald Trump’s administration took a cruel decision this past week to freeze US foreign aid for health, potentially leaving millions of people in many African countries without their life-saving antiretroviral treatment.

On Wednesday morning, Trump’s secretary of state Marco Rubio backtracked on part of that decision. But if it is not reversed permanently we can expect advances in life expectancy in sub-Saharan Africa of the past two decades to start coming undone. We can also expect HIV infection rates to start picking up again, as people with HIV start getting viral rebound and become more infectious.

The President’s Emergency Plan for AIDS Relief (PEPFAR) was started by the Republican administration led by George W. Bush in 2003. The complexity of world politics is such that the president who perhaps did more than anyone else to unravel confidence in global rules and norms – by invading Iraq – also championed a programme that has saved many millions of lives. Bush described PEPFAR as “compassionate conservatism”.

PEPFAR had bipartisan support. It is one of the greatest contributions the US has made to the world. It is now under threat by people claiming with straight faces – who came to power while the US economy is booming – to make America great again.

About $5-billion went into PEPFAR last year. Although it’s a huge amount of money it’s a tiny fraction of the US budget. It’s not straightforward to measure how many lives PEPFAR has saved but it is in the millions. This is a lot of bang for the buck.

The US government is also the largest contributor to the other major funder of global health: the Global Fund. Its future is also bleak.

Already in South Africa, vital services for extremely vulnerable clients had to pause, such as those provided by the Wits Reproductive Health and HIV Institute clinics in Johannesburg. Hopefully with Rubio’s announcement these can now resume but the situation remains chaotic and the future of this and other US-funded health programmes across Africa is fraught with uncertainty.

Opportunities

America’s abandonment of foreign aid for health relinquishes soft power. There is an opportunity here for the European Union, Canada, Australia, Japan and China to step into the breach and increase their contributions to the Global Fund, or even to directly plug holes left by PEPFAR using bilateral aid – though such funding may come too late for some.

This would not merely be an act of charity. In the post-World War II world, what has made countries great, powerful, prestigious and influential is not nastiness and murder, but investing in projects of solidarity that make the world a better place. US wars in Vietnam, Afghanistan and Iraq degraded US power. Its arming of Israel, especially during the war on Gaza, has shown US concern for universal human rights to be hypocritical and worsened its global standing. By contrast PEPFAR unequivocally enhanced its superpower status.

President Cyril Ramaphosa can display great leadership by meeting with leaders of wealthy countries and convincing them to increase spending to support the health systems of poorer countries.

But perhaps the biggest opportunity is for African countries themselves. Many remain far too dependent on foreign aid to run their health systems. A country like South Africa should be able to pay for every last cent of its health systems. Corruption and mismanagement have had an inordinate role in making this difficult.

For countries like Malawi, Mozambique and others, there is a long way to go before they can pay their own way for HIV treatment. But pressure, from within and out these countries, must be put on their governments to build robust economies capable of delivering tax revenue to spend more on health.

In a very divided world where illiberal nationalist populism is on the rise and African governments are for the most part still weak and corrupt, these opportunities seem unlikely to be seized. But we hope we are proven wrong.

Geffen is the editor of GroundUp. Low is the editor of Spotlight. Both served in the Treatment Action Campaign which successfully campaigned for HIV medicines in South Africa, as well as other countries.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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Categories : Healthcare Politics and RegulationsTags :

Healthcare Organisations React to US Withdrawal from the WHO

On By ModernMedia

One of the first acts President Trump took on assuming office again on January 20, 2025, was to unilaterally withdraw the United States from the World Health Organization (WHO). Trump complained of the WHO’s “mishandling” of the COVID pandemic, influence by other countries, and the US financial support was excessive compared to China, which “has 300 percent of the population of the United States, yet contributes nearly 90 percent less to the WHO.”

The WHO released a statement, expressing its regret at the decision and pointing out its importance: “WHO plays a crucial role in protecting the health and security of the world’s people, including Americans, by addressing the root causes of disease, building stronger health systems, and detecting, preventing and responding to health emergencies, including disease outbreaks, often in dangerous places where others cannot go.”

The organisation also took aim at Trump’s criticism of its lack of reforms: “With the participation of the United States and other Member States, WHO has over the past 7 years implemented the largest set of reforms in its history, to transform our accountability, cost-effectiveness, and impact in countries. This work continues.”

Critics say that the move would only hand China the opportunity to effectively take control of global health if it chooses to becomes the WHO’s main contributor: though the US is the single largest contributor, it contributed only $1.3 billion in the 2022-23 biennium. An affordable amount compared to the vast sums both countries spend on their militaries. While the WHO did lavish praise on China, many experts saw it as undue and perhaps concerning – but China’s contribution, while currently small, is rising: $86 million in the 2018-19 biennium. After the US, the next largest contributors are Germany ($856 million) and the Bill and Melinda Gates Foundation ($830 million).

The Society for Healthcare Epidemiology of America (SHEA) stressed the importance of global health cooperation. In a statement, the organisation wrote: “It is essential that the United States continues our connection with the WHO to coordinate surveillance, monitoring, detection, prevention, research, and response to public health threats including outbreaks, antimicrobial resistance and high consequence pathogens such as viral haemorrhagic fevers (Ebola, Marburg), Mpox, and highly pathogenic avian influenza (eg, H5N1).”

Indeed, Trump may not simply be able to withdraw by presidential decree; since the US joined the WHO by an act of Congress, it would likely take congressional approval to leave it and Trump may face a lawsuit over this.

Trump previously announced his intention to withdraw the US from the WHO in 2020, something which Gostin et al. warned in The Lancet would not work out well for the US and the world. “Withdrawal from WHO would have dire consequences for US security, diplomacy, and influence. WHO has unmatched global reach and legitimacy.” Additionally, they warned of the sheer difficulty of such a messy divorce: “The US administration would be hard pressed to disentangle the country from WHO governance and programmes.”

Categories : Environmental Effects Substance UseTags :

Pharmaceutical and Illicit Drugs Contaminating New York’s Rivers

On By ModernMedia
Photo by Bill Oxford on Unsplash

In research published in Environmental Toxicology & Chemistry, investigators sampled water from 19 locations across the Hudson and East Rivers in 2021 and 2022 to identify and quantify the prescribed pharmaceuticals and drugs of abuse that are making their way into New York City’s rivers and to determine the source of these pollutants.

Metoprolol and atenolol (blood pressure medications), benzoylecgonine (the main metabolite of cocaine), methamphetamine (a stimulant), and methadone (an opioid) were the most prevalent drugs, present in more than 60% of water samples.

More drugs and higher concentrations were detected in water contaminated by Enterococci (bacteria that live in the intestinal tract) and after rainfall, indicating an impact from sewer overflow. However, the presence of drugs in clean water and during periods of dry weather indicated that wastewater treatment plant discharge may also contribute to the presence of drugs in rivers.

“This study shows how pharmaceuticals and drugs of abuse enter the New York City aquatic environment, highlighting the necessity of improving the current water management system,” said corresponding author Marta Concheiro-Guisan, PharmD, PhD, of the John Jay College of Criminal Justice.

Source: Wiley

Categories : General InterestTags :

US Doctor Gives His Life Stopping Church Shooting

On By ModernMedia
Candle-lit vigil
Photo by Thays Orrico on Unsplash

A US doctor has been hailed as a hero after he gave his life to stop a gunman firing upon a church congregation.

The Orange County Sherriff’s Department hailed the doctor’s ultimate sacrifice following the tragic shooting, which took place at a the Geneva Presbyterian Church in Laguna Woods, California, on Sunday afternoon.

John Cheng, MD, 52, was attending a church lunch with his mother when 68-year-old David Chou chained the doors shut and opened fire on a group of elderly parishioners.

Acting without hesitation, Dr Cheng, a prominent sports medicine physician, quickly tackled the suspect, allowing church members to restrain him, according to a statement from the Orange County Sheriff’s Department.

When he leapt to the defence, Dr Cheng sustained multiple gunshot wounds and succumbed to his injuries. He leaves behind his wife and two children, as well as devastated colleagues at his practice, who referred to him as a protector, ABC 7 reported.

“Officials said that were it not for the actions of Dr Cheng, there most certainly would have been many more lives lost,” said the California Medical Association in a statement released a day after the shooting.

“Our nation continues to be plagued by an epidemic of gun violence,” they wrote. “Physicians as healers are often on the front lines of these tragic events, treating the wounds of the victims of gun violence.”

Five other victims sustained gunshot wounds and were taken to local hospitals for treatment. The suspected shooter, who is in custody and being charged with murder and attempted murder, allegedly drove from Las Vegas to attack the church, at which members of the Taiwanese Presbyterian Church have had a space since 2009. He knew no-one at the church but spent about an hour mingling with them to gain their trust, NPR reported.

The shooting is being investigated as a hate crime, since the suspect was reportedly upset about political tensions involving China and Taiwan, the sheriff’s department noted.

At a media briefing, Orange County District Attorney Todd Spitzer praised Dr Cheng’s actions.

Dr Cheng knew that there were many parishioners at risk, Spitzer said. He charged across the room, and did everything he possibly could to disable the assailant. “He sacrificed himself so that others could live,” he added.

Don Barnes, the Orange County Sheriff-Coroner, was in agreement, saying that “there is no doubt that Dr. Cheng’s actions that day saved the lives of many other church members. He is a hero and will be remembered by this community as such.”

Source: MedPage Today

Categories : Healthcare Politics and RegulationsTags :

US Stands Poised to Rescind Abortion Rights

On By ModernMedia
Photo by Andy Feliciotti on Unsplash

The US Supreme Court has voted to strike down the landmark Roe v Wade decision which constitutionally protects abortion rights, according to an initial draft majority opinion leaked by news outlet POLITICO. This comes at a time when abortion rights are being challenged in a number of US states, and such a ruling would cause abortion to become immediately illegal in 22 US states.

In 2019, there were 630 000 reported abortions in the US in 2019, according to the US Centers for Disease Control, an 18% decrease compared with 2010. Women in their 20s accounted for 57% of abortions in 2019. Abortions are highest among black American women, with a rate of 27 per 1000 for ages 15–44.

The Roe v Wade decision in 1973 gave women in the US an absolute right to an abortion in the first three months of pregnancy, and limited rights in the second trimester.

In 1992, in Planned Parenthood v Casey, it was ruled that states could not place an “undue burden” on women seeking abortions before a foetus could survive outside the womb, at about 24 weeks.

The draft opinion written by Justice Samuel Alito completely refutes the 1973 decision which guaranteed constitutional protections of abortion rights in the US, and also a subsequent 1992 decision – Planned Parenthood v. Casey – that largely maintained the right. “Roe was egregiously wrong from the start,” Justice Alito wrote.

“We hold that Roe and Casey must be overruled,” he writes in the document, labelled as the “Opinion of the Court.” “It is time to heed the Constitution and return the issue of abortion to the people’s elected representatives.”

In the past, deliberations on controversial cases have been fluid, with justices occasionally changing their votes as draft opinions circulate. This represents a rare breach of Supreme Court secrecy and tradition around its deliberations. The final, binding decision, is expected to be published in two months. Currently, five Republican appointees including Justice Alito have voted in favour of repealing Roe and Casey, while the three Democrat appointees are dissenting. It is not known how the last member, Chief Justice John Roberts, will vote.

The ruling as it currently stands would end the 49 year old US constitutional protection of abortion rights, instead allowing each US state to restrict or ban abortions outright.

POLITICO notes that public disclosure of a draft decision is unprecedented in the court’s modern history. Some observers had predicted that the conservative majority would have chipped away at abortion rights without overturning it.

The draft shows that the court is seeking to reject Roe’s logic and legal protections. “The inescapable conclusion is that a right to abortion is not deeply rooted in the Nation’s history and traditions,” Justice Alito wrote, declaring that one Roe’s central tenets, the “viability” distinction between foetuses not capable of surviving outside the uterus and those which can, “makes no sense.”

Justice Alito also described doctors and nurses who terminate pregnancies as “abortionists”, instead of the more neutral term “abortion providers” used by Chief Justice Roberts.

Source: Politico

Categories : COVID Healthcare Politics and RegulationsTags : 1 Comment

Political Factors Drove Hydroxychloroquine and Ivermectin COVID Prescriptions

On By ModernMedia
Photo by Andy Feliciotti on Unsplash

Hydroxychloroquine and ivermectin, two COVID treatments that have been shown to be ineffective for those purposes, were more heavily prescribed in the second half of 2020 in parts of the US that voted for the Republican party, according to a new research letter published in JAMA Internal Medicine.

“We’d all like to think of the health care system as basically non-partisan, but the COVID pandemic may have started to chip away at this assumption,” said lead author Michael Barnett, assistant professor of health policy and management.

The study compared prescription rates for hydroxychloroquine and ivermectin with rates for two control medications, methotrexate sodium and albendazole, which are similar drugs but have not been proposed as COVID treatments. Comparing different US counties, researchers looked at deidentified medical claims data from January 2019 through December 2020 from roughly 18.5 million adults as well as census and voting data.

Overall, hydroxychloroquine prescribing volume from June through December 2020 was roughly double what it had been in the previous year, while the volume of ivermectin prescriptions was seven-fold higher in December 2020 than the previous year. In 2019, prescribing of hydroxychloroquine and ivermectin did not differ according to county Republican vote share. However, that changed in 2020.

After June 2020 – coinciding with when the US Food and Drug Administration revoked emergency use authorisation for hydroxychloroquine – prescribing volume for the drug was significantly higher in counties with the highest Republican vote share as compared to counties with the lowest vote share.

As for ivermectin, prescribing volume was significantly higher in the highest versus lowest Republican vote share counties in December 2020 a 964% increase on the overall prescribing volume in 2019. The spike lined up with with a number of key events, such as the mid-November 2020 release of a now-retracted manuscript claiming that the drug was highly effective against COVID, and a widely publicised US Senate hearing in early December that included testimony from a doctor promoting ivermectin as a COVID treatment.

Neither of the control drugs had differences in overall prescribing volume or in prescribing by county Republican vote share.

The authors concluded that the prescribing of hydroxychloroquine and ivermectin may have been influenced by physician or patient political affiliation. “This is the first evidence, to our knowledge, of such a political divide for a basic clinical decision like infection treatment or prevention,” said Barnett.

Source: Harvard T.H. Chan School of Public Health