Over 8 000 SA healthcare jobs lost – and more could follow – after US Pepfar aid cuts

More than 8 000 healthcare workers in South Africa lost their jobs following the withdrawal of United States (US) funding for HIV/Aids programmes, Health Minister Dr Aaron Motsoaledi confirmed on Thursday.

The job losses come as a direct result of US President Donald Trump’s January 2025 announcement to withdraw the President’s Emergency Plan for AIDS Relief (Pepfar) funding from South Africa’s HIV/Aids and TB programmes.

During a media update, Motsoaledi addressed the impact of the funding cuts while countering claims that the country’s HIV response has collapsed.

Despite the significant job losses, the health minister emphasised that the vast majority of the HIV/Aids workforce remains intact and operational across affected districts.

“In these 27 districts, there were 271 606 people who are working on the HIV/Aids programmes every day. 15 539 of these were funded by Pepfar , of which, yes, we can confirm today, unfortunately, 8 061 are out of their jobs,” Motsoaledi stated.

Despite these job losses, Motsoaledi emphasised that the remaining healthcare infrastructure continues to function.

“The remaining 7 478 people are still employed because they are funded through Centres for Disease Control and Prevention, or CDC, at least until September this year. So they are still on the job and doing their work as they were normally doing,” he explained.

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Motsoaledi counters claims of HIV programme collapse

Motsoaledi expressed concern about recent media narratives suggesting the HIV/Aids programme is collapsing following the funding withdrawal.

“Over the past three weeks, there have been numerous media statements, articles and claims by prominent South Africans who are well known within the HIV/Aids cycle.

“The general thrust of the narrative is that since the announcement on the 20th of January 2025 by President Donald Trump to withdraw funding from Pepfar — the HIV-Aids programme — has collapsed or is on the verge of collapsing, or is inevitably collapsing,” he noted.

The minister challenged what he characterised as a misguided perception about where HIV/Aids work truly takes place.

“It is rather unfortunate. There is a belief that the battle against HIV/Aids can only happen in offices or government buildings, public or private. And if the campaign is not seen there in such buildings, then it means it is not happening,” Motsoaledi remarked.

He emphasised that the real fight against the epidemic happens at the community level.

“We wish to confirm today that the fight against HIV/Aids and TB is in our villages, in our communities and townships and even on the streets of our country. And that is where our focus is, has been, and as it should be.”

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Motsoaledi recalls South Africa’s historic HIV crisis

During his address, the health minister reminded attendees of South Africa’s history with HIV/Aids, particularly the devastating impact the epidemic had around 2010.

“Many here might have forgotten the real crisis brought about by HIV/Aids, which was the biggest crisis in the valley and happened in South Africa, especially around 2010, where death was an everyday occurrence,” Motsoaledi said.

“We were burying people in large numbers every day. There was a big absenteeism from work. Children were beaten as their mothers were dying.”

He highlighted the severity of the health crisis at its peak: “By that time, maternal mortality driven by this pandemic had reached a staggering 249 per 100 000 live births. I want to repeat, a staggering 249 women were dying per every 100 000 live births. And the number of children who were born HIV positive was high.”

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South Africa’s HIV response strategy

Motsoaledi detailed how South Africa responded to the crisis by implementing an ambitious testing and treatment campaign.

“As a response, we launched the world’s biggest HIV-cancelling testing and treatment campaign. We then announced that we’re going to test 15 million South Africans in one year as part of that massive campaign,” he said.

The minister recalled that some were sceptical about the feasibility of this goal.

“I want to remind you that we were never given a chance. Experts from all walks of life, including even the media, never gave us any chance because they thought we’re just going to continue along the lines of voluntary counselling and testing, or VCT, as it was called at that time, which relied on passive self-reporting where people will come into health facilities to ask and ask to be tested.”

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HIV/Aids unattainable dream achieved

He noted that critics had dismissed the government’s ambitious target.

“Our target of 15 million people was attacked as an unattainable pipe dream. And we were told that the best that we could achieve was to reach 3 million people only after one year of hard work.”

Despite these challenges, Motsoaledi explained how they adjusted their approach.

“We did not relent. We rather changed the approach from voluntary counselling and testing to what we then called HCD, HIV counselling and testing, meaning we go out in the villages, churches, places of work, communities, sport clubs, royal families, to offer South Africans counselling and testing, and to put those who are positive on ARV treatment.”

The health minister highlighted the success of this approach: “And contrary to the naysayers, I wish to remind you that we reached 18 million people in a period of 18 months in that programme.”

Despite the recent funding cuts from Pepfar, Motsoaledi emphasised that South Africa still maintains a substantial HIV/Aids workforce, with 263 354 healthcare workers continuing to deliver critical services in previously Pepfar-funded districts.

He said those previously supported under Pepfar were absorbed into public clinics and continue to receive uninterrupted treatment.

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