In South Africa, which has the world's largest HIV-positive population, patients have found themselves locked out since U.S. President Donald Trump announced last week that foreign aid programs would be suspended.
The OUT Engage men's health centre in Johannesburg, which diagnoses at least five HIV cases a day and provides medication, has a sign on its door explaining its temporary closure.
"In the short term, I hope there will be some money coming in, so that in the medium and long term we can do other projects," says the director of this health NGO aimed at the LGBTQ community, Dawie Nel.
The waiting room at the HIV Institute at the University of the Witwatersrand in Johannesburg was empty, the lights off, this week.
The well-known center explained on Facebook that its clinics for key populations, including sex workers and transgender people, would be “closed until further notice.”
The university's dean of health sciences, Shabir Madhi, said in a statement that "mitigation plans are being developed."
With a simple signature, the new American president ordered the suspension of most foreign aid programs for three months while they are evaluated.
His decision has caused panic in the most fragile countries and undermines the American aura, particularly in the face of China.
In South Africa, where AIDS wiped out an entire generation in the mid-2000s, creating an army of orphans, American aid is particularly valuable.
"The United States is an absolutely unreliable partner," regrets Dawie Nel.
– “Undue suffering” –
South Africa is one of the main beneficiaries of Pepfar, a major American programme to fight HIV/AIDS which has now been suspended.
The country still has nearly 141,300 HIV-positive people, one of the highest rates in the world.
An exemption for humanitarian aid, including life-saving treatment, has been issued since the freeze but many organisations are still unsure whether it applies to them. “It’s all still terribly chaotic,” sighs Mr Nel.
His organization was expecting some $2 million in USAID-committed funds to continue through September, he said, to provide its 2,000 patients with HIV treatment and another 4,000 clients with the preventive drug PrEP.
Africa's most industrialized country received $480.9 million in U.S. funds in 2023 for health, according to the U.S. government.
And Pepfar represents 17% of South Africa's HIV budget, providing 5.5 million people with antiretroviral treatment, according to the Department of Health, which is promising to make up for the loss of US funding.
The initiative, launched in 2003 by President George W. Bush, has saved some 26 million lives worldwide.
The freeze "will set South Africa and the world back on progress in the fight against HIV," said Anele Yawa, Treatment Action campaigner. "People will be left behind in terms of prevention, treatment and care."
With the United States being the world's largest foreign aid donor, its withdrawal "leaves a vacuum" that "creates opportunities for other countries like China" to take over, said Craig Lasher of the health advocacy group Population Action International.
The US decision comes as South Africa chairs the G20 this year, "a huge opportunity to mobilise resources" and "lead the African bloc in collective discussions with Western countries", notes Munya Saruchera, a health expert at Stellenbosch University.
But prolonged delays in filling funding gaps will cause "undue suffering for health services and patients," Lasher said. "The longer they go on, the harder it will be to rebuild programs," he warned.
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