One thing on which most people in southern Africa’s health sector agree is that it is not the actuality of the aid funding cuts made by the US but their suddenness that has caused the most pain.
Nowhere is that pain more evident than in the fight against HIV and Aids. Already, the UN Aids executive director, Winnie Byanyima, has said the cuts will mean an additional 2,000 new HIV infections each day and more than 4 million further deaths over the next four years.
Research projects have shut up shop as have clinics, while support services vanish and healthcare workers lose their jobs. Most horrifying is that the availability of anti-retroviral (ARV) medicines is slowly but surely showing signs of becoming a problem – drugs that keep many of the 39.9 million people worldwide who are living with HIV alive and well.
Last week, our reporters in South Africa, Rachel Savage and Nick Dall, took a measure of the human suffering already going on behind these statistics in two moving dispatches from inside the country which became both the centre of the Aids pandemic, and a huge force in checking the advance of the virus.
It is that heartbreaking reversal of progress – in what had perhaps been one of humankind’s most outstanding success stories of the past few decades – that has left everyone in the field devastated.
HIV used to be a death sentence; now it is something that you can not only live a full life with, but also even avoid passing to your child if you are an HIV positive woman. The number of deaths from the disease decreased from more than two million in 2004 to 600,000 in 2023.
Now, experts like Byanyima fear a return to the 1990s, when HIV medication was scarcely available in poorer countries, and infections and deaths soared. Seeing this happen in 2025 is beyond belief.
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‘We remember the silence, the denial, the deaths. We cannot go back to the dark days of gaslighting us on Aids’ 
