The Treatment Action Campaign (TAC) has voiced concerns over the R1.9 billion approved by the US President’s Emergency Plan for AIDS Relief (Pepfar) Bridge Plan, stating it is 50% less than the aid received last year.
The TAC has called for the Department of Health to take action for the provision of additional funding support for South Africa’s HIV/Aids control efforts.
The Pepfar Bridge Plan (PBP) has been approved to provide essential HIV service delivery in South Africa from October 1, 2025, to March 31, 2026.
This plan addresses a US government funding freeze that caused job losses and service disruptions earlier this year.
TAC general secretary Anele Yawa said this bridge plan is meant to keep the programme operating as it has been since February of 2025, but new cuts are being implemented.
“It represents a further 50% cut from the total amount South Africa was slated to receive last year, accounting for it being only a six-month bridge.”
Yawa noted that despite the plan not being shared with TAC, the budget implies 15 fewer districts will be getting Pepfar support, down from 27 of South Africa’s 52 districts in previous years.
He said thousands of healthcare workers, counsellors, and other non-clinical staff, like data capturers, will not be returning to clinics.
“We’re concerned that the agency allocations in the bridge funding amounts may be out of alignment with what is still operating.”
According to Yawa, since the Pepfar cuts and disruptions to services earlier in the year, there has been a system-wide slide in the basics.
TAC’s Ritshidze State of Health reports reveal significant cuts in 326 clinics across 16 districts and six provinces.
- 85% of facility managers report staffing shortages.
- 48% of staff note reduced capacity, and waiting times have increased.
- Filing systems have collapsed in King Cetshwayo and Buffalo City.
- Routine HIV testing is insufficient, with only 47% of non-ART patients being offered a test.
- HIV/Aids patients are increasingly receiving one-month refills instead of three-month or committed six-month options.
“These are not marginal dips; they are structural failures that push people out of care. The 15 districts that lost Pepfar support following this drastic funding cut will still not have the support needed to fill these gaps.”
Yawa stressed that without Pepfar, crucial drug-friendly, safe, and specialised care for drug users, sex workers, and queer and trans individuals in South African clinics is ending.
As more people rely on public health due to closed centres, this intervention will fail without extra staff, specialised services, and positive attitudes towards key populations, including opioid substitution therapy and hormonal care.
He further explained that receiving this aid does not mean that everyone who lost their jobs will get it back, and that frontline workers will be returning to all the clinics they had been in before.
“Additionally, this may result in even further cuts to service delivery support at the facility level from what we’ve already seen.”
He said there has been limited acknowledgment of the true scale of the funding gap left by Pepfar and that while the National Treasury has earmarked R753 million to cushion the shortfall, this is a fraction of the nearly R1.8 billion reduction in Pepfar funding for the six-month period previously contributed.
“Critical areas Pepfar supported like counselling, data capture, key population services, and community-led monitoring remain largely unfunded. These are not add-ons but essential components of how the HIV response stayed accountable and people stayed in care.”
The limited response so far shows little urgency to replace these functions or plan for long-term sustainability, he added.
“Until government and donors accept and address the breadth of what was lost – the people and systems that kept them reaching people – the response will remain weakened, and communities will keep paying the price,” he warned.
Yawa stated that TAC and Ritshidze also faced significant funding cuts, reducing their reach from 26 to 16 districts and leading to over a hundred retrenchments.
According to Yawa, progress has plateaued in some districts and reversed in many following the Pepfar disruptions.
He said 9% fewer people received a three-month ARV supply in January 2025 compared to previous periods, decreasing in all provinces except the Eastern Cape. Conversely, 8% more people received only a one-month supply, with notable increases in the Free State and KwaZulu-Natal.
He said shorter treatment supplies increase the likelihood of treatment interruption or patients not returning to the clinic.
Yawa said the TAC hopes that its efforts to understand the impact at the facility level will be taken seriously by the district, provincial, and national Health departments and that concrete action will follow.
“As TAC and Ritshidze, we have had to sacrifice a great deal to prioritise getting this data collection done. We urgently need greater funding support so that we can return to more facilities, restore full engagement processes, and continue our vital role in holding the health system accountable.”
