Johannesburg — The 12th South African AIDS Conference opened this week at Emperor’s Palace in Gauteng, South Africa, as pressure mounted on health systems in the host country and the region. The conference, which runs from September 8-11, drew about 1,400 delegates under the theme Unite for Change, Empower Communities and Redefine Priorities for HIV/AIDS.
Organisers are warning that U.S. funding cuts, shortages of healthcare workers, weak government response, limited mental health services, and the exclusion of migrants from care are undermining efforts to control the HIV epidemic.
A key concern is the loss of about 14,000 healthcare workers after reductions in USAID funding, worsening an already critical shortage of personnel. South Africa’s introduction of National Health Insurance and shifting global politics also add to the uncertainty facing the country’s HIV response.
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In a statement, conference co-chairs Dr. Kate Rees and Dr. Candice Chetty-Makkan said the mission remains clear – ending the AIDS epidemic. They said community-led responses and innovation is key, urging solidarity with communities whose rights are threatened worldwide.
“We must bravely innovate while staying true to community-led approaches,” the statement read. “This means uniting behind communities whose rights are under threat worldwide, supporting their resilience, and harnessing innovation to ensure that the HIV response remains dynamic and effective.”
The co-chairs also cautioned that South Africa must take a more honest and realistic view of the HIV/AIDS crisis. They said the country’s world-leading HIV programme – the largest of its kind globally – is under threat after huge cuts in U.S. support through PEPFAR. The programme previously relied on R7.5 billion annually from PEPFAR, but the South African Treasury’s pledge of R753 million in bridging funds is far from enough to sustain epidemic control.
They echoed calls from the International AIDS Society to “rebuild, rethink, and rise to the challenges”, speaking of a radical shift in planning and budget priorities is needed. “Every rand must be used efficiently and responsibly. That means rethinking business as usual and embracing innovation – from multi-month dispensing and task shifting, to harnessing AI, digital health, and behavioural economics,” their statement said.
One area of innovation under the spotlight is the introduction of lenacapavir, a new long-acting injectable PrEP for HIV prevention. Taken just twice a year, the drug offers an alternative to daily oral pills. The co-chairs said transparency will be critical, with policymakers needing to communicate rollout plans, including affordability clearly.
Treatment Action Campaign’s Chairperson, Sibongile Tshabalala-Madhlala, described the challenges faced by foreign nationals while accessing healthcare services. Tshabalala-Madhlala said there were instances where foreign nationals were confronted or excluded from accessing healthcare, and appealed for stronger government action against “medical xenophobia”.
“No one should be denied healthcare based on where they come from,” she said.
WHO Director-General Dr. Tedros Ghebreyesus, in a pre-recorded message, congratulated South Africa for responding swiftly to the impact of aid cuts. “I commend the government for moving quickly to analyse the impact of these cuts. South Africa has tried to develop and find contingency plans for each province. These cuts also bring opportunities. I commend South Africa for its commitment to strengthening domestic funding for HIV/AIDS and tuberculosis,” he said.
Deputy President Paul Mashatile, delivering the keynote address at the opening ceremony on September 8, acknowledged the uncertainty around PEPFAR’s future but said the government is committed to filling the gap. “Let me reiterate that as government we are working tirelessly to close the gap left by the USAID funding withdrawal. The fight against HIV/AIDS will not collapse; we are committed to ensuring that our programmes continue to reach those who need them most.”
He said there is a need to move beyond top-down, clinic-focused approaches, and that strategies must put power and resources into the hands of those most affected to empower communities and reset HIV/AIDS priorities, and focus on solutions that are community-owned and driven.
“This translates into deliberate action to invest in prevention strategies that are evidence-based and tailored to the diverse needs of different communities. We must ensure access to comprehensive and inclusive healthcare services that leave no one behind. And we must continue to champion education, awareness, and destigmatisation efforts that break down barriers and foster a culture of understanding and support,” Mashatile said.