The human cost of US foreign aid cuts: implications for HIV service delivery, research and innovation in South Africa

In early 2025, the abrupt suspension of U.S. foreign aid to South Africa - including funding from United States President's Emergency Plan for AIDS Relief (PEPFAR), the United States Agency for International Development (USAID), the Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH) - has triggered a multidimensional crisis in the country's HIV response. This paper synthesises emerging evidence on the human and systemic costs of these cuts, highlighting disruptions in HIV service delivery, research continuity, and health workforce stability in South Africa. As of March 2025, over 8,000 healthcare workers have been displaced, leading to service gaps in testing, treatment, and outreach to key populations. The cessation of many NIH sub-awards has halted clinical trials and weakened South Africa's global leadership in HIV research. Modelling studies project up to 500,000 excess HIV-related deaths and millions of new HIV infections if services are not restored. The paper calls for urgent, multisectoral action - including domestic funding reform, mental health integration, and research continuity - to prevent the reversal of two decades of progress and to build a more resilient, self-sustaining HIV response in South Africa.