Flash quote: MSF warns abrupt PEPFAR withdrawal puts key populations at greater risk
Antonio Flores, Senior HIV, TB Advisor, Southern Africa Medical Unit (SAMU)
“Doctors Without Borders (MSF) has been working in HIV care in South Africa since 2001, when we fought for lifesaving treatments to reach people who needed them, especially in communities like Khayelitsha. Today, despite huge progress, South Africa still has the largest HIV epidemic in the world. Withdrawing PEPFAR funding that supports prevention and treatment efforts suddenly is a decision clearly not based on science or public health needs. Instead of a responsible, planned and phased transition, this abrupt withdrawal risks undermining the support systems that decades of investment helped build. People who find it difficult to access the formal health system because of stigma or discrimination are likely to be most severely affected by this sudden termination. Ultimately, this will endanger lives.”
Background:
- Doctors without Borders (MSF) has a long history spanning over two decades of providing HIV care in South Africa. It launched a pilot HIV treatment programme providing antiretrovirals (ARVs) in Khayelitsha, Cape Town in 2001.
- On 21 June 2026, the South African National Department of Health issued a statement in response to media reports that the US government would be withdrawing all PEPFAR funding from South Africa.
- South Africa still has the world’s largest HIV epidemic, with around 8 million people living with HIV.
- South Africa has demonstrated the kind of partnership the US State Department claims to want; South Africa’s Department of Health has long run its own ARV programme, procuring 90% of its own ARVs with PEPFAR supporting other activities in 27 of 52 districts in the country.
- This sudden withdrawal risks entrenching what we have observed over the last 18 months; disruptions to PEPFAR’s work in South Africa has led to drop offs in care and closure of community-based organisations critical to reaching those least likely to access care. More than 8,000 PEPFAR-funded workers were retrenched, including nearly half of all counsellors and data capturers nationwide. Clinics experienced immediate breakdowns in patient tracking, HIV testing, distribution of medication, TB follow-up, and procurement planning. Modelling estimates suggest that discontinuing activities in South Africa that were funded by PEPFAR up to 2025, would result in 150 000–296 000 additional new HIV infections (29–56% increase) and 56 000–65 000 additional AIDS-related deaths (33–38%) between 2025 and 20281. This comes at a time where the Global Fund will also be cutting its HIV funding allocation to South Africa by 25%.
1 Meyer-Rath G, Jamieson L, Mudimu E, Imai-Eaton JW, Johnson LF. The cost of the plunge: the impact and cost of a cessation of PEPFAR-supported services in South Africa. AIDS. 2025 Aug 1;39(10):1476-1480. doi: 10.1097/QAD.0000000000004272. Epub 2025 Jun 20. PMID: 40549501; PMCID: PMC12262123. https://pmc.ncbi.nlm.nih.gov/articles/PMC12262123/
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Jane Rabothata
