A new NGO report warns that lingering effects of 2025 US Pepfar funding cuts are undermining South Africa's rollout of the six-monthly HIV prevention injection lenacapavir, despite recent US funding restoration efforts and initial shipments. Community infrastructure losses hinder uptake among high-risk groups, even as rollout begins late May.
This article is part of the series on US Pepfar Cuts Impact on South Africa HIV Services.
A report by Physicians for Human Rights, Advocacy for Prevention of HIV and Aids, and Emthonjeni Counselling & Training, released April 30, 2026, details how US Pepfar cuts—mostly ended in February 2025—dismantled community-based HIV prevention in 27 high-burden South African districts. Funded previously by USAID and CDC, these services supported testing, recruitment, and access for sex workers, gay and bisexual men, transgender people, and young women.
Interviews with 40 stakeholders (doctors, nurses, peer counsellors, community members) in Cape Town, Khayelitsha, Philippi, Midrand, and Johannesburg (Sept 2025 and March 2026) revealed the timing's irony: infrastructure collapsed just as lenacapavir preparation ramped up. Mobile services were replaced by overburdened clinics with long queues and stigma.
South Africa received its first two shipments of 37,920 lenacapavir doses from the Global Fund in late March and early April 2026. This nearly foolproof injection against sexual HIV transmission could end Aids as a public health threat by 2043 if scaled to 1-2 million people annually. However, co-author Emily Bass emphasized the need for the 22-year US-SA platform to reach at-risk groups.
The cuts also ended Dreams programs, which increased prevention uptake 1.4 times among teen girls and young women (30% of new infections despite 8% population share). Avac data shows PrEP uptake fell 25% daily from Jan-Sep 2025 vs. 2024. Amid February 2026's $5.88B US HIV funding package (see prior coverage), advocacy director Yvette Raphael urges new donors like Gilead Sciences.