The withdrawal of US aid since February 2025 has led to a significant drop in HIV viral load tests in South Africa, according to data from the National Health Laboratory Service. Public health experts warn this signals serious setbacks in the country's HIV management program. While viral rebound rates have decreased, the reasons remain unclear.
South Africa's public health system requires annual HIV viral load tests for all patients to monitor the effectiveness of antiretroviral (ARV) medicines in suppressing the virus. However, data obtained by GroundUp and Spotlight through the Promotion of Access to Information Act reveals a marked decline in these tests since February 2025.
The National Health Laboratory Service (NHLS) recorded 4,521,738 viral load tests from February to September 2025, slightly lower than the 4,554,463 in the same period of 2023. A biostatistician’s analysis using linear regression from 2015 data showed this figure is statistically significantly lower than expected, with p-values below 0.05 in all provinces except Limpopo. The decline accounts for the NHLS data hack in 2024, which caused some missing records.
This downturn coincides with the US administration's reduction in global aid following Donald Trump's inauguration on January 20, 2025. Billions of rands were withdrawn from South Africa, leading to closures of services for vulnerable groups, including the Ivan Toms Centre in Cape Town and Wits University facilities in Johannesburg. US funding also supported data collection systems.
Public health experts accuse the government of denial regarding the impacts. Health Minister Aaron Motsoaledi claimed in May 2025 that a record number of people had started ARVs, a statement disputed by epidemiologists.
Despite the setbacks, South Africa's HIV program continues to treat millions effectively, outperforming aid-dependent nations like Mozambique. Notably, the percentage of viral rebound cases—where patients have over 1,000 HIV copies per drop of blood—has decreased in 2025. This could stem from the improved ARV regimen including dolutegravir, or from the loss of vulnerable patients from specialist US-funded clinics. The exact cause varies by province and remains undetermined.