Latest news with #Bhekisisa
Mail & Guardian
16-07-2025
- Health
- Mail & Guardian
SA gets R520 million to buy the twice-a-year anti-HIV jab – but there's a snag
Research indicates the anti-HIV jab, lenacapavir, protects women completely and works almost as well for men, transgender and nonbinary people. Photo: Marko Milivojevic/Pixnio South Africa has accepted an offer of just over $29 million (about R520 million) from the Global Fund to Fight Aids, TB and Malaria to buy the twice-a-year anti-HIV jab, lenacapavir, But there's a snag. The country isn't getting extra money from the fund to buy the medicine; it has to use cash from a grant that it has already been awarded and that was cut by 16% in June. Moreover, the fund, at this stage, won't tell the health department — or any of the other eight countries it has selected for early roll-out — how much they're paying lenacapavir's maker, Boitumelo Semete-Makokotlela, the chief executive of the country's medicine regulator, Bhekisisa it is aiming to have lenacapavir registered in South Africa before the end of the year. According to the health department's head of procurement, Khadija Jamaloodien, the lenacapavir funds from the Global Fund will become available in October, when the roll-out period of South Africa's next grant, known as Grant Cycle 7, kicks in. But roll-out — probably in early 2026 — can only start once Sahpra has registered the medicine, the country's essential medicines list committee has reviewed and recommended lenacapavir, procurement processes are in place and health workers and clinics have all they need to hand the drug safely to patients. Two studies released last year showed the medicine In fact, Ending Aids as a public health threat means reaching a stage where fewer people are getting newly infected with HIV than the number of people with HIV who are dying (increasingly for other reasons than HIV, for example old age). According to the The Global Fund money for South Africa is, however, not nearly enough to put two to four million people a year in South Africa on the lenacapavir jab (see price explanation below) — and even if it was, the country's health system won't be able to roll the medicine out that fast, scientists and policymakers say. Will the US help to pay for the jab? The fund's offer follows the body's announcement on July 9, that it has the 'ambition' to finance enough lenacapavir for two million HIV-negative people — in the low- and middle-income countries it supports — over the next three years. But fulfilling this ambition The US government's Aids fund, Pepfar, And, although some activists say it's still possible for the US administration to come on board (lenacapavir is The Global Fund's offer, however, is a way to get branded, 'bridging' doses from Gilead to South Africa while the world waits for cheaper generics to become available around 2027. 'We now stand at a moment of reckoning and a moment of choice,' Mitchell Warren, the executive director of the international advocacy organisation, Avac, told Bhekisisa at the 'While a lot of the choices over the last six months have been made by an American politician [Donald Trump] who doesn't care about the pandemic or science generally, our choice is to make decisions based on the science that we all now know. Which is that lenacapavir is our most potent opportunity.' Countries have to budget just under R600 per dose Jamaloodien, however, cautions further discussions with the Global Fund and Gilead will be needed about the governance around the pricing of the product. 'We have a transparent pricing system, guided by the In a Global Fund letter sent in early July to the nine early roll-out countries — South Africa, Zimbabwe, Eswatini, Lesotho, Zambia, Mozambique, Kenya, Uganda and Nigeria — the fund asked the governments to budget for $60 (about R1 076) per patient a year ($30, or R576, per six-monthly dose), to buy lenacapavir. But in the document, which Bhekisisa has seen, the fund makes it clear that the amount 'reflects the country contribution only, to be used for budgeting purposes, and should not be considered the product price'. Jamaloodien has confirmed that the health department did receive such a letter. The letter also states that the gap between the price that the fund pays Gilead per patient a year and the $60 that countries will pay for with their Global Fund grants, will be covered by private sector funding, which Bhekisisa will be paid for by a $150 million (about R2.68 billion) donation of the UK-based Furthermore, says Jamaloodien, South Africa's letter instructs the country to submit its first order, for planning purposes, by 30 September under an 'agreed procurement mechanism'. Why does Gilead not want to talk about LEN's price? Lenacapavir, also referred to as LEN for short, was registered for HIV prevention — also called PrEP — by the US medicines regulator, the Food and Drug Administration The US is the only country in which LEN has been registered so far as PrEP. For low- and middle-income countries such as South Africa, Gilead said it will have a 'not-for-profit' price such as the one they negotiated with the Global Fund, but isn't allowing the fund to make it public. Several scientists and activists at the HIV science conference, have, however, told Bhekisisa the rumoured not-for-profit price that Gilead has negotiated with the Global Fund is $100 per person a year, and Avac, But neither Gilead or the Global Fund have confirmed this amount. If South Africa budgets for $60 per person a year, the $29.2-million that Global Fund says we can use to buy lenacapavir, translates to putting and keeping about 400 000 people on the medicine over three years (Global Fund grants run for three years at a time). Gilead argues because the not-for-profit price is based on the actual cost of making lenacapavir, and shipping it to countries, it can't declare that cost. 'Gilead doesn't publicly disclose manufacturing costs for any of our medications,' Caroline Almeida, Gilead's head of public affairs, told Bhekisisa in Kigali. But activists don't buy this argument. 'Gilead's secrecy will obstruct civil society activism for lower drug prices and keep prices high in middle-income countries [such as South Africa] where Gilead negotiates prices directly,' the Avac has identified 16 top lenacapavir markets, of which South Africa is — by far — the largest because of the country's high number of new HIV infections. The country's And But for LEN to be affordable, activists argue, Gilead needs to be open about its price. 'Such secrecy undermines the power of buyers to negotiate affordable prices and violates the human rights of all people to access information and lifesaving tools,' activists said in Warren concludes: 'Pricing transparency has been a long-standing challenge, as companies try to balance their commercial pricing and marketing strategies with their global public health strategies. We clearly need a new model or compact for pricing that helps break the cycle of small thinking and limited impact.' This story was produced by the . 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Mail & Guardian
18-06-2025
- Health
- Mail & Guardian
Elon Musk, depression and South Africa's cowboy ketamine clinics
What's ketamine all about? Bhekisisa recently spoke with Bavi Vythilingum, a member of the South African Society of Psychiatrists, who helped write the guidelines for ketamine use to understand more about the drug and how it works. (Wikimedia) 'To be clear, I am NOT taking drugs!' the richest man in the world The New York Times was lying their ass off.' Elon Musk — originally from South Africa and until recently the head of the Trump administration's so-called 'I tried prescription ketamine a few years ago and said so on X, so this [is] not even news. It helps for getting out of dark mental holes, but I haven't taken it since then,' he told The New York Times. Musk also In South Africa, treatment-resistant depression is Musk has openly talked about Because ketamine causes temporary ' These psychedelic effects, and the fact that ketamine can make people feel happier, are part of the reason why ketamine is also used as a street drug, often known as 'Vitamin K' or 'Special K'. Musk told The Don Lemon Show that ' In South Africa, In 2022, ketamine Bhekisisa the spray isn't available in the country. Some healthcare providers in South Africa are also administering the drug In the case of ketamine, the South African Society of Psychiatrists (Sasop) has But Bhekisisa's TV programme, Health Beat , Sahpra's chief executive, Boitumelo Semete-Makokotlela, Experts say unregulated use of ketamine is not only risky — it can be deadly, In an autopsy, authorities in Los Angeles found that Friends actor Matthew Perry, who played the character Chandler Bing and wrote about his Mia Malan recently spoke to psychiatrist Bavi Vythilingum, a member of the Bhekisisa 's May episode of Mia Malan (MM): Why are psychiatrists talking about ketamine right now? Bavi Vythilingum (BV): It's probably MM: Why does it work so fast? BV: We're not 100% sure, but we think that it's because it's MM: What is a BV: Glutamate is a brain neurotransmitter like serotonin and noradrenaline. Glutamate is situated throughout the brain and ketamine works on that receptor. MM : So it's something that helps you to feel good? BV : If you're taking ketamine, for example, for drug use, it would produce an altered state of consciousness, which can make you feel good, but can also be unpleasant. But certainly, for depression, MM: So who gets ketamine? Is it people who need to be helped immediately, and then you wean them off it? Or how does it work? BV: So there are two groups of people who would get ketamine: people who are MM: And if you then put such a patient on ketamine, explain to us what happens. BV: Most people who have ketamine will have what we call a MM: And for how long would that last? BV: For as long as we give the infusion. So usually about 40 minutes. Then they go home and they come back after two to three days for a total of about six infusions. MM: And what happens after that? BV: There's no MM: What about addiction? BV: We have to assess somebody very carefully for previous substance use and current substance use. So if somebody is an active substance user, even if they're not using ketamine — say they're an alcoholic — you'd be very cautious about giving ketamine. MM: Who can give ketamine? We have heard of many clinics that give it where it's not psychiatrists giving it, where a GP gives infusions. Is that legal? BV: It is technically not illegal, because any doctor can give any medication. That's a MM: What does ketamine treatment cost? And do medical aids pay for it? BV: You're looking at about R2 400 to R2 500 per infusion. The big cost of that is around personnel because you need an anaesthetically trained doctor and a nurse. MM: Do medical aids pay? BV: Medical aids are starting to pay. So your top-tier medical aids will pay for ketamine upon motivation, but the medical aids are reluctant to pay. And a big cause of the reluctance is all these so-called cowboy ketamine clinics. The medical aids are saying, quite rightly, that they don't know if ketamine is going to be given safely. This interview appeared in a recent episode of Bhekisisa 's monthly TV programme, . This story was produced by the . Sign up for the .
TimesLIVE
06-06-2025
- Health
- TimesLIVE
It's the ‘Donald disease' that's making us sick
As stakeholders duke it out, those with most to lose from HIV funding cuts tell Bhekisisa they have been left to fend for themselves — bad news for all of us By 'Hello, sis. How are you? I hope you're fine. I mean, I'm not.' A lot has been going on out there, he told Bhekisisa in the voicemail, one of the many we recently received. 'You know, I'm a gay guy. I have sex with other men, without wearing condoms now, because when I try to fetch them from my local clinic, I'm told I get judged and told I want too many. You know what's happening in our industry,' he said. We will call him Nkosi. Because he has sex with men and because his industry is sex work and because no-one in the small community where he lives knows that he is gay or what he does for work. He even has a 'girlfriend' so people will think he's straight. Sex work has always been a dangerous profession. But ever since the Trump administration stopped most of its HIV funding in February, it's become even more risky. The World Health Organization says gay and bisexual men like Nkosi's chance of contracting HIV through sex is 26 times higher than that of the general population. Male sex workers are even more likely to get infected with the virus. That is what makes sex workers, as well as gay and bisexual men, what researchers call a ' key population ' in the HIV world. Other key populations are transgender people, people who inject drugs, and, in Africa, also young women between the ages of 15 and 24. Because so many new HIV infections happen in these groups, the US government's Aids fund, Pepfar, has, for the past decades, invested most of its funds in programmes working with these groups. But the 12 specialised clinics for key populations, supported by Pepfar, have now been shut down. Gone, too, are their health workers specially trained in how to work without discrimination. Gone is their tailor-made HIV treatment and testing services; their specialised mental health support; and the condoms and lubricants they handed out for protection against HIV and other sexually transmitted infections. Gone are the two-monthly anti-HIV jabs that some of these clinics handed out as part of studies — and the daily anti-HIV pills, which they distributed without judgement. Though government clinics also stock the daily anti-HIV pill, which, if used correctly, can reduce someone's chance of getting HIV through sex to close to 0, people like Nkosi, research shows, are often treated badly by health workers at state clinics, making them wary to return. Preventive medicines like the daily pill are called pre-exposure prophylaxis, or PrEP, because they stop infection by preventing a germ such as HIV from penetrating someone's cells. 'So sometimes I don't have PrEP,' says Nkosi. 'A partner can tell me he is on PrEP, but I don't trust that. Because where is he getting PrEP? Where am I going to get it? The black market? I don't know if it is even the real thing. Is it a counterfeit? Lube? That's another thing — you use everything, anything, as long as it's got jelly in it. The last time I did that I had an itchy penis for a week.' Nkosi calls the domino effect of the Trump administration's decision to pull funding 'the Donald disease, because it is being caused by this guy, one man. It's like crossing the freeway every day the way we're living now. One day, I know I'm gonna die.' What's with key populations? But why is there so much focus on these communities? UNAids says more than half of all new infections in 2022, around the world, came from key populations — and infections don't stay within those groups. 'Even the most self-interested people should be heavily invested in treatment and prevention of these populations,' says Francois Venter, who heads up the health research organisation, Ezintsha, at Wits University. 'There's no clean, magical division between key populations and general populations. It's a Venn diagram of married men sleeping with sex workers, of drug-using populations interacting with your ostensibly innocent kids, gay men with your straight-presenting son, all needing HIV prevention and treatment programmes.' Though we have medicines like PrEP to prevent people from getting infected with HIV and antiretroviral drugs (ARVs) for HIV-infected people, which, if taken correctly, reduce their chance of transmitting the virus to others to 0, having the medications available is just a small part of the solution. What's more difficult is to get medication to people and to convince people to use it, and to use it correctly. Researchers estimate that of South Africa's 8-million people with HIV, 1.1-million are not on treatment. Some of the 1.1-million choose not to start treatment, but an even larger proportion, who do go on treatment, cycle in and out of it Studies, for example, show that getting people to use the anti-HIV pill, also called oral PrEP, each day, has been a struggle — and those who do use it, often don't use it each day. The less often it's used, the less well it works. Moreover, UN targets that South Africa needs to reach by the end of 2025, show that we struggle to convince people who know they're infected with HIV, to take treatment — and stay on it. Researchers estimate that of South Africa's 8-million people with HIV, 1.1-million are not on treatment. Some of the 1.1-million choose not to start treatment, but an even larger proportion, who do go on treatment, cycle in and out of it. Pepfar programmes funded thousands of 'foot soldiers', such as community health workers, adherence counsellors, data collectors and youth workers, who went into communities with mobile clinics to find people who stopped their treatment, or to make ARVs easier to get by making it possible for people to collect their medicine from community halls, shops or private pharmacies close to where they live. That's why having lost at least half of those workers — we're likely to lose the other half at the end of the US financial year in September — is such a tragedy. And why, if we do nothing to replace them, modelling studies show, there's a high chance that we see up to almost 300,000 extra HIV infections over the next four years and a 38% increase in Aids deaths. The difficulty with state clinics and key populations Government clinics are mostly not geared towards key populations, because they serve everyone. And because many health workers' own prejudices so often interfere with the way they treat patients such as sex workers, gay and bisexual men, or teens who ask for condoms or PrEP, such groups frequently feel uncomfortable to use state health services. Stigma and discrimination in public clinics — doled out by security guards, cleaners, health workers and patients in waiting rooms — keep people away from HIV treatment and prevention. Researchers who surveyed more than 9,000 people in key populations found that less than half, and in some cases not even a quarter, said they were treated well; about one in five said they were blocked from getting services. Motsoaledi says he's trying to fix that by now training 1,012 clinicians and 2,377 non-clinician workers at government facilities in non-discriminatory healthcare. But despite similar trainings having been conducted for years already, discrimination remains rife. Because funding cuts mean already understaffed government health clinics now have even fewer staff, many people with HIV, or those wanting PrEP, have to travel further for treatment, or wait in long queues. As politicians, activists and researchers duke it out from labs and clinics and press conferences, many of those most at risk, like Nkosi, have been left to fend for themselves. Here are some of their stories — we collected the stories via voice notes with the help of health workers who worked for Pepfar programmes that have now been defunded. Female sex worker: 'My child is going to be infected' 'Yoh, life is very hard. Since all this happened, life has been very, very hard. 'I have tried to go to the public clinic for my medication. But as sex workers, we are not being helped. We are scared to go to the government clinic to treat sexually transmitted infections because we are seen as dirty people who go and sleep around. We even struggle to get condoms. We are now forced to do business without protection because it is our only source of income and it's the way that we put food on the table. My worry now is that I am pregnant and my child is going to be infected because I'm not taking my ARVs, and I have defaulted for two months now.' Transgender woman: 'The future is dark' 'I'm a transgender woman. My pronouns are she. 'When the clinic closed, I was about to run out of medication so I went to the government clinic in my area. I introduced myself to the receptionist and the lady asked me what kind of treatment I was taking. I told her ARVs and that I'm virally suppressed [when people use their treatment correctly the virus can't replicate, leaving so little virus in their bodies that they can't infect others], so I can't transmit HIV to others. 'The lady told me that they can't help me and I need to bring the transfer letter. I told her that the clinic is closed so I don't have the transfer letter. I asked to speak to the manager and the manager also refused to help me. The manager! How can she let someone who is HIV-positive go home without medication? 'I had to call one of my friends and she gave me one container. If you're not taking your medication consistently, you're going to get sick, you're gonna die. And the future? The future is dark.' Migrant farm worker: 'Lose my job? Or risk my health?' 'When we were told that the clinic was closed, I was actually in another town trying to get a seasonal job on the farms. But when I went to the nearest clinic, I was told that I needed to get a transfer letter. So I ended up sharing medication with friends. But then their medication also ran out. 'Then I got a job on the farm. Before the mobile clinics came to the farms and we had our clinical sessions there. The nurse was there, the social worker was there. Now we went to the clinic and spent the whole day there because we had to follow the queues. And because our jobs were not permanent jobs, you know, you just get a job if you apply by the gate. So if you are not there by the gate on that day, then the boss will automatically think that you are no longer interested in the job, so they employ someone else. 'I went to the government clinic and asked to get at least three months' supply. But the clinic said no because it was my first initiation so I had to come back. So I went back to the farm to see if I could still have my job. I found that I was no longer employed because they had to take up someone else. 'What am I going to do? If I go to the clinic, I stand a chance of losing my job. If I stay at my job I am at risk of getting sick.' Trans woman: 'I'll just stay home and die' 'Accessing treatment is difficult because of the long queues. Even that security guard keeps on telling me to go away when I ask for lubricants and he tells me every time there's no lubricants. 'We need the trans clinic back. I need to speak to somebody, a psychologist. On Tuesdays we had our psychologist come in, and the doctor. But now I don't have the funds to go and see even a psychologist. 'It is bad. It is super bad. I don't know when I last took my meds. Another friend of mine just decided, oh, OK, since the clinic is closed and I no longer have medication, I'll just stay home and die.'
Mail & Guardian
05-06-2025
- Health
- Mail & Guardian
It's the ‘Donald disease' that's making us sick
US President Donald Trump. 'Hello, sis. How are you? I hope you're fine. I mean, I'm not.' A lot has been going on out there, he told Bhekisisa in the voicemail, one of the many we recently received. 'You know, I'm a gay guy. I have sex with other men, without wearing condoms now, because when I try to fetch them from my local clinic, I'm told I get judged and told I want too many. You know what's happening in our industry.' We will call him Nkosi. Because he has sex with men and because his industry is sex work and because no one in the small community where he lives knows that he is gay or what he does for work. He even has a 'girlfriend' so people will think he's straight. Sex work has always been a dangerous profession. But ever since the administration of US President Donald The World Health Organisation says gay and bisexual men like Nkosi's chance of contracting HIV through sex That is what makes sex workers, as well as gay and bisexual men, what researchers call a ' But the Gone, too, are their health workers specially trained in how to work without discrimination. Gone is their tailor-made HIV treatment and testing services; their specialised mental health support and the condoms and lubricants they handed out for protection against HIV and other sexually transmitted infections. Gone are Preventive medicines like the daily pill are called 'So, sometimes I don't have PrEP,' says Nkosi. 'A partner can tell me he is on PrEP, but I don't trust that. Because where is he getting PrEP? Where am I going to get it? The black market? 'I don't know if it is even the real thing. Is it a counterfeit? Lube? That's another thing — you use everything, anything, as long as it's got jelly in it. The last time I did that I had an itchy penis for a week.' Nkosi calls the domino effect of the Trump administration's decision to pull funding 'the Donald disease because it is being caused by this guy, one man'. 'It's like crossing the freeway every day the way we're living now. One day, I know I'm gonna die.' What's with key populations? When Health Minister But why is there so much focus on these communities? 'Even the most self-interested people should be heavily invested in treatment and prevention of these populations,' says Francois Venter, who heads up the health research organisation, 'There's no clean, magical division between key populations and general populations. It's a Venn diagram of married men sleeping with sex workers, of drug-using populations interacting with your ostensibly innocent kids, gay men with your straight-presenting son, all needing HIV prevention and treatment programmes.' Although we have medicines like PrEP to prevent people from getting infected with HIV and antiretroviral drugs (ARVs) for HIV-infected people, which, if taken correctly, Studies, for example, show that getting people to use the anti-HIV pill, also called oral PrEP, each day, Moreover, the Some of the 1.1 million choose not to start treatment, but an even larger proportion, who do go on treatment, Pepfar programmes That's why having lost at least half of those workers — The difficulty with state clinics and key populations Government clinics are mostly Stigma and discrimination in public clinics — doled out by security guards, cleaners, health workers and patients in waiting rooms — keep people away from HIV treatment and prevention. Motsoaledi Because funding cuts mean already understaffed government health clinics now have even fewer staff, many people with HIV, or those wanting PrEP, have to travel further for treatment or wait in long queues. Here are some of their stories — we collected them via voice notes with the help of health workers who worked for Pepfar programmes that have now been defunded. Female sex worker: 'My child is going to be infected' 'Yoh, life is very hard. Since all this happened, life has been very, very hard.' 'I have tried to go to the public clinic for my medication. But as sex workers, we are not being helped. We are scared to go to the government clinic to treat sexually transmitted infections because we are seen as dirty people who go and sleep around. 'We even struggle to get condoms. We are now forced to do business without protection because it is only our source of income and it's the way that we put food on the table. My worry now is that I am pregnant and my child is going to be infected because I'm not taking my ARVs, and I have defaulted for two months now.' Transgender woman: 'The future is dark' 'I'm a transgender woman. My pronouns are she.' 'When the clinic closed, I was about to run out of medication so I went to the government clinic in my area. I introduced myself to the receptionist and the lady asked me what kind of treatment I was taking. I told her ARVs and that I'm virally suppressed [when people use their treatment correctly the virus can't replicate, leaving so little virus in their bodies that they can't infect others], so I can't transmit HIV to others. 'The lady told me that they can't help me and I need to bring the transfer letter. I told her that the clinic is closed so I don't have the transfer letter. I asked to speak to the manager and the manager also refused to help me. The manager! How can she let someone who is HIV-positive go home without medication? 'I had to call one of my friends and she gave me one container. If you're not taking your medication consistently, you're going to get sick, you're gonna die. And the future? The future is dark.' Migrant farm worker: 'Lose my job? Or risk my health?' 'When we were told that the clinic was closed, I was actually in another town trying to get a seasonal job on the farms. But when I went to the nearest clinic, I was told that I needed to get a transfer letter. So I ended up sharing medication with friends. But then their medication also ran out. 'Then I got a job on the farm. Before the mobile clinics came to the farms and we had our clinical sessions there. The nurse was there, the social worker was there. Now we went to the clinic and spent the whole day there because we had to follow the queues. 'And because our jobs were not permanent jobs, you know, you just get a job if you apply by the gate. So if you are not there by the gate on that day, then the boss will automatically think that you are no longer interested in the job, so they employ someone else. 'I went to the government clinic and asked to get at least three months' supply. But the clinic said no because it was my first initiation so I had to come back. So I went back to the farm to see if I could still have my job. I found that I was no longer employed because they had to take up someone else. 'What am I going to do? If I go to the clinic, I stand a chance of losing my job. If I stay at my job, I am at risk of getting sick.' Transwoman: 'I'll just stay home and die' 'Accessing treatment is difficult because of the long queues. Even that security guard keeps on telling me to go away when I ask for lubricants and he tells me every time there's no lubricants. 'We need the trans clinic back. I need to speak to somebody, a psychologist. On Tuesdays we had our psychologist come in, and the doctor. But now I don't have the funds to go and see even a psychologist. 'It is bad. It is super bad. I don't know when I last took my meds. Another friend of mine just decided, oh, okay, since the clinic is closed and I no longer have medication, I'll just stay home and die.' *These stories were edited for length and clarity. This story was produced by the . Sign up for the .
Daily Maverick
29-05-2025
- Health
- Daily Maverick
Trump's HIV funding cuts will also exacerbate diabetes, cervical cancer and depression
The impact of the Trump administration slashing of more than half of South Africa's HIV and TB projects funded by the US government, transcends reduced access to HIV testing and HIV prevention and treatment drugs. Treatment for diabetes, high blood pressure, cervical cancer, depression and anxiety will become harder to come by too. The impact of US President Donald Trump's administration slashing more than half of South Africa's HIV and TB projects, transcends reduced access to HIV testing and HIV prevention and treatment drugs: treatment for noncommunicable diseases (NCDs) will become harder to come by too. As government clinics take on HIV patients who were previously treated by the President's Emergency Plan sor Aids Relief-funded projects, the treatment of diseases like diabetes and heart disease — for all people — will come under pressure. And mental health issues such as depression and anxiety — also noncommunicable illnesses — will most likely become more common among people with HIV, because many now face extra stress, such as having to travel further to clinics for treatment, and groups like sex workers increasingly face discrimination at government clinics. At a Bhekisisa and Southern African HIV Clinicians Society webinar in May, the health advocacy organisation Treatment Action Campaign (TAC) and the sex worker movement Sisonke, for example, reported cases where sex workers — who used to get their treatment from US government-funded clinics where health workers were trained to address their reproductive health needs — have recently been turned away from state clinics or were denied condoms. In 2020, noncommunicable diseases were the cause of more than half of all deaths in South Africa. But, compared to HIV, funding for noncommunicable diseases has traditionally been scarce. We look at five ways in which HIV funding cuts could affect noncommunicable diseases. Fewer data capturers means fewer people to keep track of NCDs Today, people over 50 make up the second-largest group of South Africa's HIV-positive population, Bhekisisa's data team has found. Twenty years ago, they were the smallest proportion. As people age, their chances of developing health problems like high blood pressure, heart disease and diabetes rise, which means more and more people will have to be treated for these conditions — on top of getting HIV care. Because antiretroviral drugs (ARVs) keep people healthy and increase their life expectancy, the scale-up of treatment in South Africa — public sector treatment started in 2004 and in 2025 we've got about six million people on ARVs — means that most people with HIV and who take ARVs correctly now live just as long as those without the virus. So, as the peak of the HIV-infected population shifts into an older age band, more and more people will probably have to be treated for noncommunicable diseases like heart conditions, diabetes, overweight and high blood pressure — on top of receiving HIV care. Studies have shown that people with HIV who are older than 50 have double the chance of having conditions like diabetes or high blood pressure than younger HIV-positive people. But without tracking the numbers — which will be challenging with the loss of thousands of US government-funded data capturers in the wake of foreign aid cuts — putting plans in place to care for an ageing HIV population will be hard. And with many countries' governments, including South Africa's, scrambling to find the money to replace the thousands of data capturers for HIV programmes previously funded by the US government after the abrupt halt in aid, funds for tracking the health conditions of older people with HIV will probably be a low priority. Employing health workers to capture and manage health data would be a hard sell, said Kate Rees, a public health specialist with the Anova Health Institute, during the Bhekisisa and the Southern African HIV Clinicians Society webinar — something that, for a public health issue that might be ignored because its fallout wasn't immediately visible — could just make the problem so much worse. Fewer people on ARVs leads to more people with diabetes When people with HIV are not on treatment, or if they don't use their ARVs correctly, the virus gets a chance to make copies of itself in their bodies and attack their immune systems. That's when their immune systems get weak, and some then fall ill with diseases that scientists call opportunistic infections. The most common opportunistic infection for people with untreated HIV is tuberculosis (TB). And that's where the catch for one of the world's fastest-rising noncommunicable diseases, diabetes, lies: there's a link between TB and diabetes. Diabetes — a condition in which someone has too much sugar in their blood because their body doesn't get or respond to the signal from the hormone insulin to absorb glucose — kills more people in South Africa than any other disease. In 2020, it claimed 32,100 lives — about 40% of them before they turned 65. The condition is one of four noncommunicable diseases World Health Organization (WHO) member countries agreed to tackle. The goal is to lower deaths by 25% by the end of this year. But South Africa is far off track and that goal will now be even harder to achieve. TB changes how someone's body reacts to insulin. That's why some people with TB — who have never been diagnosed with diabetes — are found to have lots of sugar in their blood. In some cases, this is temporary and normalises after TB treatment. But the germ still increases the odds of developing diabetes later on. In fact, among people who have high sugar levels in their blood when getting diagnosed for TB, studies show that between 8% and 87% are eventually diagnosed with diabetes. But, the opposite is also true: people with diabetes have a higher chance of falling ill with TB. So, in short: when there's less money to help people with HIV get diagnosed or to make it easy for diagnosed people to get on to treatment, and stick to it, more people get TB. And when more people have TB, diabetes becomes more common, because some people with TB are more likely to get diabetes. At the same time, people with diabetes who get TB, have a higher chance of falling very ill with TB, because diabetes makes their immune systems even weaker. Fewer women on ARVs means more with cervical cancer Last week, the Clinical HIV Research Unit at Wits University in Johannesburg shut its cervical cancer screening and prevention clinic at Helen Joseph Hospital, one of the biggest units in the country, following the termination of US funding. 'This closure will significantly impact cervical cancer prevention efforts in South Africa, which faces one of the highest rates of cervical cancer in the world,' the unit said in a press release. Cervical cancer is the second most common cancer among South African women, after breast cancer, but it's the leading cause of cancer-related deaths — even though it's preventable through vaccination and regular screenings such as pap smears and testing for the human papillomavirus (HPV), which causes most cervical cancer cases. 'With timely screening and early detection being key to preventing cervical cancer, the closure of this screening unit at Helen Joseph Hospital leaves a major gap in services and will further strain the health service,' the unit's communication department said. Women with untreated HIV infection are much more likely to develop cervical cancer after being infected with cancerous forms of the HPV virus, because their immune systems are too weak to clear the virus without treatment. Cervical cancer is the most common cancer among black South African women, who are also the group with the highest HIV infection rate in the country. About a quarter of people with HIV in South Africa are not on antiretroviral treatment. USAid programmes that have now been discontinued helped to find them by sending community health workers into communities to test people for HIV and find people who had already been diagnosed with HIV, but fell off treatment. The ending of USAid programmes has resulted in fewer HIV testing and treatment services, which in turn affects how many women become vulnerable to developing cervical cancer. Depression and anxiety will become more common Mental health conditions are also noncommunicable diseases. If more people with HIV are left without treatment as a result of US government funding cuts, mental health conditions like depression and anxiety will likely become more common. Why? Because Pepfar funded counsellors who would find people with HIV and get them on treatment immediately after they were tested. Without ART, some people develop HIV encephalopathy, a condition that damages brain tissue through inflammation from the virus. Encephalopathy raises the chances of depression or anxiety because it harms the areas of the brain that control movement, emotions and memory. People with HIV already face stigma that causes stress and anxiety that can lead to depression. 'There's still the shame, stigma and moral issues that come with HIV,' says Francois Venter, an HIV doctor and the director of Ezintsha at the University of the Witwatersrand. Depression makes it harder for people to stick to their treatment. Studies show that people with HIV and depression are more likely to stop taking their medication — weakening their bodies and raising the chances of them dying from opportunistic infections. Fewer nurses means noncommunicable diseases fall through the cracks Noncommunicable diseases are underdiagnosed in South Africa, experts say. 'If we went into the community aggressively looking for high sugar and blood pressure, we would do such a better job,' says Venter. 'Instead, we sit back and wait([until people turn up at clinics), which is why we do so badly with diabetes and hypertension.' Even at clinics, people are rarely tested, mostly because there are too few nurses at our clinics. On top of noncommunicable diseases, they also have to help treat HIV and gender-based violence, and see that pregnant women and newborn babies are healthy. And after February's US funding cuts, we have even fewer nurses. According to health department data, Pepfar funded 2,320 nurses, of which just over half (those programmes that received their funds through USAid) have now been laid off. Right now, the rest (programmes funded through the Centres for Disease Control and Prevention), only have jobs until the end of September. Pepfar also funded 2,705 lay counsellors, health department data shows. Without this staff who went into communities to screen people for HIV, TB and other diseases, patients now have to travel to clinics for help, which means more patients for nurses. And when nurses have more work, they have less time to treat each patient, which, says Venter, makes it even harder to pick up on noncommunicable diseases. 'Because of that, the actual interaction would take probably an hour and a half. When you've got a mile-long queue outside your door, you just don't have that time.' 'So they (nurses) go for the absolute basic stuff.' DM
