'Some won't survive': US cuts threaten S.Africa's young HIV patients

The lively 45-year-old aid worker, who did not want to give her real name, used to spend her days visiting hundreds of HIV patients in South Africa's Msogwaba township around 300 kilometres (190 miles) east of Johannesburg.

But since President Donald Trump slashed US foreign aid funding in late January, Elsie has been forced to stay at home, forbidden from contacting her patients.

"I was supporting 380 kids, making sure each and every kid is taking his medication, is virally suppressed, each and every kid is not being discriminated or violated," she recalled.

"We teach them to accept themselves as they are, to know they are loved. I take them as my own children."

The non-governmental organisation she worked for, which she did not want to identify in case of repercussions, supported almost 100,000 people per year including many HIV-positive children, orphans and child-headed households. USAID provided the group with more than $3 million a year in funding.

Elsie was one of upwards of 100 community health workers tasked with monitoring the children, checking in on their well-being and facilitating access to the lifelong treatment they require to stay healthy and avoid transmitting the virus.

Now unable to visit them, she said she fears the worst.

"My fear is that they won't take their medication," she sighs. Some children have gone missing since the programme ended, she says. She is worried that others might miss their hospital appointments.

"We know each and every one of those kids and their problems. Some of them won't survive."
'More than medicine'
South Africa has one of the highest rates of HIV/AIDS in the world, with around 13 percent of the population -- or 7.8 million people -- living with the virus, according to government data.

In 2023 there were about 640,000 children orphaned by the virus in the country.

The government has assured the cuts will not affect its rollout of antiretrovirals (ARVs). In February, it launched a campaign to extend the lifesaving treatment, which already reaches 5.9 million patients, to 1.1 million additional people by the end of the year.

"The country has got capacity to provide... HIV treatment to people living with HIV because almost 90 percent of the current treatment is purchased through the fiscus/government budget," health department spokesperson Foster Mohale told AFP.

But the US President's Emergency Plan for AIDS Relief (PEPFAR) -- among those hit by the funding cuts -- supported numerous programmes focusing on prevention, counselling and monitoring, and amounted to 17 percent of South Africa's overall HIV response.

"It's about much more than medicine," said Sibongile Tshabalala-Madhlala, who chairs the Treatment Action Campaign, a leading HIV advocacy organisation.

"It's about a person finding a friendly healthcare worker at the facility. It's about understanding the challenges of people living with HIV and their needs. It's about prevention, and keeping people in care."

The funding cuts will severely impact human resources in already understaffed and overcrowded hospitals, she fears, including by extending waiting periods.

The PEPFAR cuts alone meant 15,000 workers lost their jobs, Health Minister Aaron Motsoaledi has said.
'Abandoned'
A study published in the Annals of Internal Medicine in February suggested that cutting all PEPFAR funding to South Africa could lead to more than 600,000 additional HIV-related deaths over the next decade.

While the Department of Health said this figure was merely "assumptions", Tshabalala-Madhlala told AFP she believes "people will die".

"People won't be able to miss work to get their medication. Some are already sharing ARVs. With this disruption, we will see a rise of infection rates and more HIV-related deaths," she said.

Sitting in his mother's house on a dirt road in Msogwaba, a scrawny 17-year-old holds his head in his hands. The teenager, who Elsie believes shows signs of autism, is worrying about his next appointment.

Previously, Elsie would accompany him to the clinic. "She helped him a lot whenever he was struggling," sighed his mother, who cannot afford to take time off work to accompany her son. "I feel that we've been abandoned."

Elsie said she felt the same. "I was forced to abandon them -- they really trusted me."