The year 2025 marks 25 years since Nkosi Johnson took the stage at the 13th International AIDS Conference in Durban. The 11-year-old HIV/AIDS activist was watched by the world and addressed a delegation of more than 10,000 people, including world and industry leaders. South Africa at this time was a drastically different landscape to what it is today in its struggle against HIV/AIDS. Since then, approximately seven million people in South Africa have been on life-saving treatment, a feat made possible by the government’s national health department. The country has seen its fight against this epidemic become one of the most significant responses in the world; a stark difference to the stigma, fears and isolation faced by those who had contracted the virus just two decades ago.
Mark Heywood, a South African human rights and social justice activist, in his 1998 article, Human Rights and AIDS in South Africa: From Right Margin to Left Margin, accurately predicted the effects of the political stance of the time on the outcome of the efforts against the epidemic. He argued that South Africa’s ability to combat the HIV/AIDS epidemic would be seriously hampered by the government’s failure to address structural inequalities, integrate human rights principles into HIV/AIDS legislation, and launch a comprehensive HIV/AIDS treatment programme on time. He was correct. The political scepticism and denial of the impact of the virus by the former government of the time saw the death toll rise to approximately 330,000 deaths in five years between the years 2000 and 2005.
The landmark ruling of Minister of Health and Others v. Treatment Action Campaign and Others (the TAC case) affirmed the Section 27 right to access health care enshrined in our Constitution. The Constitutional Court delivered the words, “The magnitude of the HIV/ AIDS challenge facing the country calls for a concerted, co-ordinated and co-operative national effort in which government in each of its three spheres and the panoply of resources and skills of civil society are marshalled, inspired and led. This can only be achieved if there is proper communication, especially by government.” This is the rallying call which saw the court order the government to make antiretroviral drugs accessible to HIV-positive pregnant women to stop the virus from being passed on to unborn babies.
What followed this judgment was a snowball effect that ultimately resulted in the mobilisation of HIV/ AIDS treatment plans. It laid the foundation for addressing the issue of human rights violations by integrating rights, particularly socioeconomic rights, into the HIV response through supportive legal and policy frameworks; policies such as the Broad Framework for HIV/AIDs and STI Strategic Plan for South Africa, 2007-2011.
2025 is also the year which has seen unprecedented political shifts, nationally and internationally. This is South Africa’s first year under the new Government of National Unity (GNU), a first in the country’s democratic history. This year also includes South Africa’s continued stance against Israel in the Palestinian conflict and South Africa’s growing political and international stance as a member of BRICS, representing the global south.
On 20 January 2025, the United States government, through an executive order titled, “Reevaluating and Realigning United States Foreign Aid” announced a 90-day freeze on all US foreign aid. The United States government has, for more than two decades, been the steadfast leader in the global HIV/AIDS response through the US President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight HIV/AIDS, TB and Malaria and through its support to the Joint United Nations Programme on HIV/AIDS (UNAIDS). United Nations statistics place US foreign aid at more than US$ 100 billion to date in the global fight against HIV/AIDS, with the US accounting for around 73% of donor funding for HIV/AIDS worldwide. In a presentation to Parliament, Health Minister Dr Aaron Motsoaledi mentioned that approximately 20% of South Africa’s annual HIV/AIDS response consisted of billions of rands from US foreign aid.
Even though the courts have provided the legal mandate by which HIV/AIDS care and treatment could legally be accessible in the public health system, the actual soldiers on the front lines are the NGOs, health workers, volunteers, and the people on the ground whose dedication it has been to make resources available for HIV/AIDS treatment that have ensured that the judgment did not remain mere words on paper.
It is not surprising then that these front line soldiers would be the first to feel the impact of the executive order. On 21 February 2025, the Parliamentary Monitoring Group Standing Committee addressed the impact US foreign aid cuts would have on the Western Cape’s healthcare services. One of the key issues discussed was the financial impact. It was mentioned that R365 million had been lost for this financial year in the Western Cape alone due to the funding cuts. This affected ten NPOs listed in the report and the G2G programme, which was directly funding 700 healthcare workers.
The sudden ‘overnight’ withdrawal of aid also meant the loss of funding for hundreds of donor-funded organisations and clinics throughout the country which administer life-saving treatment. Not only that, but this decision threatens to jeopardise years of HIV/ AIDS research. Ironically, it was Human Rights Day on 21 March, the day that celebrates strides made to protect the vulnerable in our country, but the opposite has happened. That weekend saw a few cancellation letters being sent to various health organisations announcing the suspension of grants. One of those organisations, the Wits Health Consortium at the University of the Witwatersrand, which oversees HIV/AIDS clinical trials and donor-funded initiatives, received cancellation letters that Friday night.
Amidst the adversity, the government has seen that this is an opportunity for self-reliance. Dr Aaron Motsoaledi said he no longer wanted South Africa to depend on aid. “It’s only that you remember the era when PEPFAR started when people offered your money; you couldn’t reject it. But I believe it was something that we should not have allowed to flourish.” Better management of the national fiscus to ensure sovereignty is to the advantage of not just the most vulnerable in our country, but also so as not to be at the ‘mercy of others’, to the advantage of our politicians.
South Africa, the young democratic nation that it is, is no stranger to adversity. Nelson Mandela’s Rainbow-nation arose out of adversity.
What is to arise from this new adversity is yet to be seen.
