Will Budget 3.0 plug the HIV/Aids funding hole?

With less than a week before the third version of the 2025 Budget will be presented in parliament, there is still a question mark over whether Finance Minister Enoch Godongwana will make extra funds available for HIV/Aids programmes in South Africa.

Budget 3.0 – as it is being referred to – will be presented to the National Assembly on Wednesday, 21 May.

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On Thursday morning, Health Minister Aaron Motsoaledi addressed the media to give an update on the impact of the recent funding cuts on South Africa’s HIV/Aids Programme.

In February, US President Donald Trump terminated funding for the President’s Emergency Plan for Aids Relief (Pepfar) and the United States Agency for International Development (USAID) programmes in South Africa, which had supported TB and HIV prevention, testing, and treatment services across the country.

Read:
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Almost a fifth of the funding for South Africa’s HIV/Aids programme has come from Pepfar.

A subsequent study, commissioned by the Department of Health to help it with a business case for increasing domestic HIV/Aids funding, shows that if all Pepfar funding ceases, the government will need to spend an additional R13.4 billion to R28.4 billion between 2025 and 2028 to keep HIV/Aids services going, BusinessLIVE reported earlier.

“We still haven’t had responses from our own Treasury about what is going to happen [with extra funding],” Motsoaledi said in response to a question on Thursday.

“And the second question, will we get more money? I don’t want to answer that question before the budget is read on the 21st. I’ll speak to you after the budget. I can’t pre-empt anything.”

Minister in The Presidency Khumbudzo Ntshavheni confirmed on Thursday that the third version of the budget has been approved by cabinet. The approval comes after lengthy negotiations among parties within the government of national unity (GNU). One of the main points of contention was the 0.5 percentage point Vat hike presented in the second budget, which was legally challenged by the DA.

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The wrangle was ultimately resolved out of court, with Godongwana agreeing to withdraw the contested fiscal framework and its associated Vat increases.

National Treasury was, however, tasked with finding R75 billion in savings over the medium term. How and where these savings will come from is expected to be the focal point of Wednesday’s budget speech.

Nowhere near collapse 

The sudden withdrawal of US funding for South Africa’s treatment programmes has led to the closure of numerous clinics and the loss of employment for more than 8 000 healthcare workers.

This has reportedly already resulted in lower HIV testing, especially among pregnant women, infants, and young adults, raising concerns about potential increases in the rate of HIV transmission.

Motsoaledi says there is however a false narrative that South Africa’s HIV/Aids treatment programme is about to collapse following the withdrawal of US funding.

“Over the past three weeks, there have been numerous media statements, articles and claims by prominent South Africans who are well known within the HIV/Aids cycle,” he notes.

Read: US funding cuts have crippled our HIV work – Professor Glenda Gray

“The general thrust of the narrative is that since the announcement on the 20th of January 2025 by President Donald Trump to withdraw funding from Pepfar, the HIV-Aids programme has collapsed or is on the verge of collapsing, or is inevitably collapsing.

“Under no circumstances will we allow this massive work, performed over more than a decade and a half, to collapse and go up in smoke because President Trump has decided to do what he’s done.”

While acknowledging the loss of over 8 000 healthcare workers funded by Pepfar, Motsoaledi adds that “every effort” is being made to ensure patients receive their medication from other clinics and to train more clinicians to assist them.

Despite the significant job losses, he emphasises that the majority of the HIV/Aids workforce remains intact and operational across the affected districts.

“In these 27 districts, there were 271 606 people working on the HIV/Aids programmes every day. Of these, 15 539 were funded by Pepfar, and unfortunately, we can confirm today that 8 061 are out of their jobs,” Motsoaledi notes.

The remaining 7 478 people are still employed because they are funded through the Centres for Disease Control and Prevention, or CDC, at least until September this year.

Imminent US visit 

Motsoaledi was asked to weigh in on President Cyril Ramaphosa’s working visit to the US from 19 to 22 May, where he will also meet with Trump to discuss bilateral matters and try to ease diplomatic tensions.

Since the US president’s inauguration in January, relations between South Africa and the US have gone awry, to such an extent that Trump has threatened to boycott this year’s G20 meeting, which South Africa is hosting.

Read: US agencies banned from working on SA G20 Summit – report

“Am I optimistic? I’m an eternal optimist by nature,” Motsoaledi responded. “The good thing is that our president is going, but I’m not in a position to declare I’m optimistic or pessimistic [about the visit to the US] – because of the manner in which [president] Donald Trump works.”

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