On 28 January 2025, Future Families, a non-profit organisation that provides social services to orphans and vulnerable children and people infected with HIV and AIDS in South Africa, was forced to stop all activities.

Of 59 staff operating in Limpopo, “43 of us are put on unpaid leave. We have stopped all of our activities. Everything is stagnant,” says Casey Nyathela, a Future Families programme manager.

It is one of many non-governmental organisations that rely on funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), or the U.S. Agency for International Development (USAID). The executive orders issued by US President Donald Trump in January to pause foreign aid for 90 days has upended vital health services worldwide, resulting in organisations being forced to shut their doors almost immediately after receiving “stop work” orders.  

“We provide trauma containment to victims of gender-based violence (GBV). We refer them for post-exposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP) services [for HIV prevention] and provide emergency transport funds for the victims. We also ensure they get long-term psychosocial support,” explains Nyathela. 

Future Families also provides social and reproductive health literacy, financial literacy as well as mentorship to adolescents and young people. 

Peer Counselling

Peer counselling is a key intervention in the fight against HIV. Kamo Diba*, 26, regularly received counselling from peer counsellors at Nobody Clinic outside Polokwane. She’s concerned about the forced absence of peer educators and peer counsellors at government-owned primary healthcare facilities.

“If it were not for these young peers, I would probably have long died of HIV or suicide after knowing my status. Peers are easy to listen to and relate with and they respond to questions. When they don’t know something they refer you to others up the chain.

“I also sympathise with these dedicated peer counsellors and peer educators. Where will they get jobs if the government cannot absorb all of them?” she says.  

Thabang* is a peer educator or treatment navigator stationed at a health facility in Ekurhuleni. His day-to-day job involved supporting those newly diagnosed with HIV and those already on ART. 

“We were told to stop work on 30 January at the last hour before our knockoff time. We received no notices prior, we were just told to stay at home and wait for communication.” 

*Thabang tells Health-e News that he is already seeing the impact of the “stop work” orders. 

“I can’t put a feeling to it as it just happened recently, I am still in disbelief as I see a lot of people who were relying on treatment, stopping treatment or defaulting. They were relying on the support we provided them when it comes to their ART adherence.” 

At this stage, it’s unclear when or if Thabang will resume his duties. He doesn’t even know if he will receive a salary at the end of February. A worker at Anova Health Institute expresses the same concerns. 

“Everyone is devastated; it looks like we won’t get our salaries from February going forward. We are even strictly forbidden to talk about this crisis to the media,” he tells Health-e News. 

Overcrowded Clinics and increased workload

Nonhlanhla Mazaleni is the founder of Tholulwazi Phakathi, an NPO based in Soweto  that provides phyco-social support to adolescents and young adults. She tells Health-e News that there’s been a significant change in the type of services available to young people. 

“Youth-friendly services at facilities are no longer available, which were previously provided by USAID. The clinics are now overcrowded. Many young people are unable to access PrEP because they have to wait in long lines. We no longer have adherence clubs that were hosted at the clinics.”

A senior staff member at a local clinic in the South of Johannesburg says the “stop work” order has left their facility understaffed.

“We are very much affected by these uncertainties because, through these US-funded programmes, our facility was supplied with staff members who were enrolled nurses, sisters, data capturers and tracers. Now we need to do all the work. This is causing backlogs because we are doing duties that were assigned to other staff members who were told not to come to work the following day. No formal notices were issued, we are really concerned,” she says.  

Unclear waver 

The US has since issued a waiver that allows for a continuation of humanitarian aid including life-saving medicines. This would allow for HIV and TB testing, prevention and treatment to carry on for 90 days, but the situation at Future Families remains bleak.

“Even after the announcement of the waiver we have not heard anything from funders,” says Nyathela from Future Families.  

The organisation is supported by Networking HIV and AIDS Community of Southern Africa (NACOSA), which in turn relies on PEPFAR and USAID.

The US government says it’s preparing the documentation that organisations will need to “resume activities covered under the limited waiver”. 

Government must step up 

The Democratic Nursing Organisation of South Africa (DENOSA) says that the government must ensure the crucial health services continue.

“According to our Constitution, the Department of Health must guarantee the right to health, which means whatever programme that is running in the country must not be compromised by the withdrawal (of US aid),” says DENOSA national spokesperson Sibongiseni Delihlazo. 

A group of local health advocacy groups made a similar plea in a letter to the President, and the Ministers of Health and Finance last week. The group called for a plan to reduce reliance on foreign assistance awards in future. 

PEPFAR funding accounts for 17% of South Africa’s HIV budget. Last month Health Minister Dr Aaron Motsoaledi said the country pays for 76% of the HIV programmes. Twenty-seven percent of the country’s 52 districts are funded by PEPFAR.

“The total number of people on the ground who are dealing with HIV/AIDS in those 27 districts is 271 606. Of the 271 606 people, 256 452 are funded by South Africa from the fiscus. That leaves us with 15 145 people, who will be affected by the withdrawal.

“Our biggest problems will be the salaries and the operational costs. That is what we are looking at with National Treasury,” Motsoaledi said.

 The minister said the government would however continue to purchase antiretroviral and TB medication from its coffers and contributions made by private medical aid schemes as well as funding from the Global Fund.

 Motsoaledi urges people on antiretroviral and TB medication not to stop the treatment because that would result in dire health complications.-Health-e News. 

*Not their real names