Health and HIV Services Face Life-Threatening Risks Due to US Funding Cuts

Johannesburg – Over the years, Ritshidze has accumulated numerous testimonies and generated extensive data illustrating how individuals discontinue their ARVs due to the inadequate conditions in our clinics.

The lengthy waiting times and subpar treatment can make individuals anxious about visiting the clinic, driving some entirely out of care.

This is why TAC has been advocating for the establishment of more community-based locations where individuals can collect their ARVs, closer to their homes or workplaces.

These “external pick-up points,” which can include pharmacies, churches, or even the Post Office, provide people with the option to collect their ARVs outside the clinic — thereby avoiding lengthy queues.

This approach makes it faster, easier, and more convenient for those living with HIV to obtain their ARVs — ensuring adherence to treatment and enhancing long-term retention.

Additionally, it alleviates the overall pressure on our overcrowded clinics and overworked healthcare providers. It’s a win-win situation.

Some of these pick-up points have been operated by NGOs funded by the U.S. government.

Crucially, PEPFAR-funded staff have been instrumental in supporting the national and provincial supply chain systems that facilitate the dispensing, pre-packing, and delivery of medications by contracted private service providers at these external pick-up points.

However, following the suspension of U.S. funding in South Africa, numerous individuals living with HIV have reported delays in their collection schedules, lacking clear guidance on when they can retrieve their medications.

This situation jeopardizes treatment adherence, especially if individuals exhaust their supply of pills before the newly scheduled collection date. We spoke with Maite from Limpopo, who shared her story:

For the last four years, Maite Letsoalo has received a three-month supply of her antiretroviral (ARV) medication at an external pick-up point within a pharmacy in Capricorn, Limpopo.

Receiving her ARVs at the pick-up point has significantly improved her management of her condition, allowing her to avoid the long waits typically associated with clinic visits.

However, everything changed in late February when she received an SMS from the pharmacy.

The message informed her of a delay in dispensing her ARVs and stated that she would be notified of a new collection date.

After two days passed without an update, Maite found herself in a state of panic.

“I am very worried; it is causing me stress. Right now, I’m relying on extras from the days I missed my medication,” Maite says.

“I’m even sharing pills with my partner, who is in the same situation since he also collected his ARVs from the pharmacy. His phone is broken, so he has no idea about his collection date.”

Maite was diagnosed with HIV in 1999, but she only started treatment in 2012 – eight years after ARVs became available in the public health system.

“Back then, it was quite challenging; I survived with the support of my group, learning about healthy living and stress management,” she recalls.

“I had just vitamin B and antibiotics.

“When I finally got my ARVs in 2012, it made a significant difference because my CD4 count was extremely low and declining quickly, which was quite frightening.”

Maite expresses that she is experiencing the same fear now as the disruptions and delays in accessing ARVs present a looming crisis.

“It is very perilous for those of us who have already begun treatment because when we cease taking the pills, our CD4 counts deplete rapidly, and the medication may become ineffective,” she adds, highlighting the risk of developing resistance due to treatment interruptions.

Maite previously served as the coordinator for the adherence club at the Rethabile Clinic in Capricorn before the initiative was discontinued in 2017.

This occurred after Global Fund resources for adherence clubs were redirected to other needs, and the Department of Health promised to manage and facilitate the clubs but never followed through.

For this reason, Maite is well-known at the clinic, and she believes it would be easier for her to navigate the clinic queues if she must resort to collecting ARVs at the clinic, should the external pick-up point not reopen. She also recognizes that this makes her one of the “fortunate” ones.

She states: “For many individuals, that won’t be possible because the clinics frequently provide poor treatment, and the queues are excessively long. As a result, people will end up defaulting.”

“The government must understand that for many of us who are unemployed, purchasing medication isn’t an option; we need to rely on the clinics, yet they’re failing to assist us properly,” she emphasizes.

“The government needs to ensure that external pick-up points are operational and reinstate adherence clubs,” Maite urges.

“These clubs were vital because they allowed individuals to access their medications promptly without standing in lengthy clinic queues.”

Patients also benefited from ongoing counseling and mutual support.

Having survived through the most challenging times of the HIV/AIDS epidemic in the country and living with HIV for 13 years before starting treatment, Maite understands how difficult it can be to maintain a positive mindset while living with the virus.

Currently, she believes this is one of the most challenging periods for South Africa’s HIV response.

If the government cannot be transparent about the challenges this situation is causing and ensure individuals have a continuous supply of their medications, many will simply stop trying to remain on treatment.

“With the issues arising from America, it’s challenging to stay strong; I won’t deny it,” Maite admits.

“These delays in getting ARVs to the community, coupled with poor communication, could cost lives.”

“We cannot revert to the days of merely burying individuals; HIV should not be a death sentence.”

The government has initiated a campaign to enroll an additional 1.1 million individuals in HIV treatment, but this will not be feasible if it continues to become increasingly difficult for people living with HIV to obtain their ARVs and maintain their treatment.

We urge the South African government to intervene in light of the suspension and loss of U.S. government funding to ensure that services remain in place, including the continuation of external and facility-based pick-up points, which simplify the process for individuals living with HIV to collect their treatment.

This article is part of a series that TAC is gathering to shed light on the realities within our clinics following the suspension of U.S. government funding.

Stay updated by following our website and social media channels, where we will share testimonies that reveal the impact on the lives of individuals living with HIV and other public health service users.

To understand how we are impacted by the funding suspension, please visit: https://www.tac.org.za/news/us-funding-cuts-to-health-and-hiv-services-threaten-lives/