A critical juncture: Reimagining a unified, integrated HIV response in South Africa

Authors

  • K Rees Anova Health Institute, Johannesburg, South Africa, and Department of Community Health, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0002-0584-0557
  • G Wolvaardt Foundation for Professional Development, Pretoria, South Africa
  • T Chidarikire World Health Organization, Pretoria, South Africa
  • J J Dietrich Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • L Ibisomi Epidemiology and Biostatistics Division, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg South Africa, and BAMMISHO Health and Demographic Surveillance System Node, Rustenburg, South Africa
  • T Kufa-Chakezha Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa
  • T Mabuto The Aurum Institute, Johannesburg, South Africa
  • G Maimela Foundation for Professional Development, Pretoria, South Africa
  • E Mudimu Department of Decision Sciences, University of South Africa, Pretoria, South Africa
  • L Scott Wits Diagnostic Innovation Hub, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • P Smith Desmond Tutu Health Foundation, Cape Town, South Africa
  • N Sohaba South African National AIDS Council, Centurion, South Africa
  • C Chetty-Makkan Health Economics and Epidemiology Research Office (HE2RO), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

DOI:

https://doi.org/10.7196/SAMJ.2026.v116i1.4454

Keywords:

HIV, health system financing, PEPFAR

Abstract

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References

1. Joint United Nations Programme on HIV/AIDS. About the impact of US funding cuts on the global HIV response. Geneva: UNAIDS, 2025. https://www.unaids.org/en/impact-US-funding-cuts/About (accessed 11 March 2025).

2. Chigwedere P, Seage GR, Gruskin S, Lee TH, Essex M. Estimating the lost benefits of antiretroviral drug use in South Africa. J Acquir Immune Defic Syndr 2008;49(4):410-415. https://doi.org/10.1097/ qai.0b013e31818a6cd5

3. Joint United Nations Programme on HIV/AIDS. AIDS, crisis and the power to transform: UNAIDS Global AIDS Update 2025. Geneva: UNAIDS, 2025. https://www.unaids.org/sites/default/files/2025- 07/2025-global-aids-update-summary_en.pdf (accessed 11 March 2025).

4. Nachega JB, Serwadda D, Abimiku A, Sikazwe I, Abdool Karim Q. PEPFAR at 20 - a game-changing impact on HIV in Africa. N Engl J Med 2023;389(1):1-4. https://doi.org/10.1056/NEJMp2304600

5. Zuma K, Simbayi L, Zungu N, et al. The HIV epidemic in South Africa: Key findings from 2017 National

Population-Based Survey. Int J Environ Res Public Health 2022;19(13):8125. https://doi.org/10.3390/

ijerph19138125

6. Meyer-Rath G, Jamieson L, Mudimu E, Imai-Eaton JW, Johnson LF. The cost of the plunge: The impact and cost of a cessation of PEPFAR-supported services in South Africa. AIDS 2025;39(10):1476-1480. https://doi.org/10.1097/QAD.0000000000004272

7. Venter F. Slow-motion denialism - our leaders are allowing the HIV response to collapse. Daily Maverick, 22 July 2025. https://www.dailymaverick.co.za/article/2025-07-22-slow-motion-denialism- sas-leaders-allowing-hiv-response-to-collapse/ (accessed 1 October 2025).

8. MalanM.ThecaseoftheministerandtheHIVactivists:Areweenteringdenialism2.0?BhekisisaCentre for Health Journalism, 21 May 2025. https://bhekisisa.org/health-news-south-africa/2025-05-21-the- case-of-the-minister-and-the-hiv-activists-are-we-entering-denialism-2-0/ (accessed 1 October 2025).

9. JohnsonT.MinisterMotsoaledi-wearenotAfriForum.Wearethereasonyouhaveahealthsystemto defend. Health-e News, 16 May 2025. https://health-e.org.za/2025/05/16/minister-motsoaledi-we-are- not-afriforum-we-are-the-reason-you-have-a-health-system-to-defend/ (accessed 1 October 2025).

10. Skosana S. Calls for South Africa to build sustainable HIV programmes, reduce reliance on donors. Health-e News, 10 September 2025. https://health-e.org.za/2025/09/10/calls-for-south-africa-to- build-sustainable-hiv-programmes-reduce-reliance-on-donors/ (accessed 1 October 2025).

11. Fatti G, Ngorima-Mabhena N, Tiam A, et al. Community-based differentiated service delivery models incorporating multi-month dispensing of antiretroviral treatment for newly stable people living with HIV receiving single annual clinical visits: A pooled analysis of two cluster-randomised trials in southern Africa. J Int AIDS Soc 2021;24(S6):e25819. https://doi.org/10.1002/jia2.25819

12. World Health Organization. Updated recommendations on service delivery for the treatment and care of people living with HIV. Geneva: WHO, 2021. https://www.who.int/publications/i/ item/9789240023581(accessed 1 October 2025)

13. Bekker LG, Das M, Abdool Karim Q, et al. Twice-yearly lenacapavir or daily F/TAF for HIV prevention in cisgender women. N Engl J Med 2024;391(13):1179-1192. https://doi.org/10.1056/NEJMoa2407001

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Published

2026-02-09

Issue

SAMJ Vol. 116 no. 1

Section

Editorials

License

Copyright (c) 2026 K Rees, G Wolvaardt, T Chidarikire, J J Dietrich, L Ibisomi, T Kufa-Chakezha, T Mabuto, G Maimela, E Mudimu, L Scott, P Smith, N Sohaba, C Chetty-Makkan

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How to Cite

1.
Rees K, Wolvaardt G, Chidarikire T, Dietrich JJ, Ibisomi L, Kufa-Chakezha T, et al. A critical juncture: Reimagining a unified, integrated HIV response in South Africa. S Afr Med J [Internet]. 2026 Feb. 9 [cited 2026 Apr. 18];116(1):e4454. Available from: https://www.samajournals.co.za/index.php/samj/article/view/4454

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