Minister of Health Aaron Motsoaledi stated that while there may be a decline in HIV testing following the funding cuts by the United States’ President’s Emergency Plan for AIDS Relief (Pepfar), the country’s HIV/Aids programme is not collapsing.
This comes after Reuters reported this week that data from an unpublished document by the National Health Laboratory Service, a government entity, seen by the agency, showed that viral load testing declined by up to 21% among key groups in the last two months.
For individuals with HIV undergoing anti-retroviral therapy, viral load testing quantifies the amount of virus present in their bloodstream.
Viral load testing for individuals aged 15-24 declined by 17.2% in April compared to last April, after dropping 7.8% year-on-year in March. Overall population testing decreased 11.4% in April, according to Reuters.
Maternal viral load testing was down 21.3% in April, after declining by 9.1% in March. Early infant diagnostic testing was also down 19.9% in April after declining by 12.4% in March.
Additionally, nationwide, viral suppression rates among tested individuals decreased by 3.4% in March and 0.2% in April. Young adults experienced even greater declines, suggesting potential disruptions in patient treatment, the data showed.
During a briefing on the status of the HIV/Aids and TB Campaign in South Africa, the Minister said that he has never stated that everything is fine in the country following the funding withdrawal.
“I never said everything is fine. All I said is that it’s wrong to say the campaign of the HIV/Aids programme in South Africa is collapsing because it’s not… If viral load testing has dropped, does it mean the collapse of the campaign by any stretch of imagination? No, we expected that some of these problems will occur, but we are sitting with them every day,” he said.
According to reports, the Centre for the AIDS Programme of Research in South Africa (Caprisa) community programmes head and Treatment Action Campaign (TAC) deputy general secretary, Patrick Mdletshe, stated that the decline in viral load testing in South Africa can be attributed to funding cuts, particularly from Pepfar.
“These cuts have significantly impacted HIV testing and treatment programmes, especially among vulnerable populations such as pregnant women, infants, and young adults,” he said.
Mdletshe said that some of the key factors contributing to the decline are reduced funding and closure of NGO-run clinics primarily funded by Pepfar, which will consequently increase the risk of HIV transmission and lead to the disruption of treatment.
Professor Wolfgang Preiser, who heads the Medical Virology Department of Pathology at Stellenbosch University and the NHLS at Tygerberg Hospital, said that while they have seen a decline of test volumes for those markers recently, this decline cannot be attributed to the Pepfar cuts as there are other, parallel issues that also affect how many samples are received for testing.
He said some of these parallel factors are based on internal rearrangements within the NHLS between its different laboratories.
“When looking at NHLS test figures from year to year, you should factor in the network downtime last year following the cyberattack. That is long resolved but it is reflected in test volumes still,” added Preiser.
Kate Rees, public health specialist from the Anova Health Institute, said the organisation’s programmes have been terminated. “We cannot say to what extent there is a decline in the indicators. I have seen NHLS and Department of Health data that shows a decline in viral load testing nationally and HIV testing in Johannesburg. But it is not my data.”
Networking HIV and AIDS Community of Southern Africa (Nacosa) spokesperson, Sophie Hobbs, said their Pepfar-funded programme that monitored viral loads of children and adolescents in the city of Cape Town has also been terminated.
Hobbs said Nacosa has, as a result, not been able to collect this data.
She stated that according to the latest Thembisa Model estimates, there are significant gaps for children and youth in the Western Cape, with only a 67% antiretroviral therapy coverage rate and a 73% viral suppression rate in children under 15.
“Before it was terminated, our programme in Cape Town had very good treatment adherence (100%) and viral suppression rates,” said Hobbs.
The Minister further explained that of the R46.8 billion South Africa spends on the HIV/Aids programme, only R7.9bn was from Pepfar.
“It is inconceivable that out of R46.8bn spent by the country on the HIV programme, the withdrawal of R7.9bn by President Donald Trump will collapse the entire programme,” he said.
The Minister said since the Pepfar funding was pulled, in the 27 high-HIV burden Pepfar-supported districts, out of 57 across the country, there are 2,772 public health facilities.
He said in these 27 districts, there were only 12 specialised clinics independent from the government, managed by the NGOs providing services mainly for key populations funded by Pepfar. Key populations include transgender individuals, men who have sex with men, sex workers, and people who inject drugs.
“In these 27 districts, the total number of these key population clients served by these 12 specialised clinics was 63,322, of which 41,996 are found in the City of Johannesburg,” he said.
Motsoaledi said when the Pepfar-funded clinics were closed, the Department removed their files from those clinics to the nearest public facilities.
“We can confirm that all 63,322 have been moved. Then the work to contact their owners to transfer them to public health facilities where their files are started in earnest and still continues,” he said.
The Minister highlighted that there are other prominent funders like the Global Fund that have been supporting the country with health services for key populations. “34 designated facilities are funded by the Global Fund for this purpose across Gauteng, Free State, North West, Limpopo, Eastern Cape, KZN, Mpumalanga, and Western Cape.”
