South Africa’s massive HIV response has hit a significant roadblock. The country's leading mathematical tool for tracking HIV trends, the Thembisa model, has released its latest estimates. They reveal that the South African HIV treatment programme recorded its slowest annual growth in two decades.
Between 2024 and 2025, the number of people receiving antiretroviral treatment (ART) increased by just 40,000. Total enrollment rose marginally from 6.14 million to 6.18 million people. For context, annual growth in the national programme has not dropped below 100,000 in roughly 20 years.
US Funding Reductions Impact The South Africa HIV Treatment Programme
These new figures offer a clear national snapshot of recent geopolitical and economic shifts. Specifically, they highlight how the withdrawal of United States aid has affected the domestic healthcare sector. However, independent experts caution against blaming the funding cuts entirely. Growth in the national HIV response had already begun to decelerate before the American aid reductions took effect.
Fortunately, the worst-case scenarios have not yet materialised. A study published in the journal AIDS last year warned that severe US funding reductions could trigger a 28% drop in ART coverage. It also predicted a 56% spike in new infections and a 38% rise in deaths.
The latest Thembisa data includes Department of Health figures up to August 2025. This marks about six months after the first US budget cuts took effect. While a total collapse has been avoided, researchers warn that worse long-term consequences could still emerge.
Prevention And Care Gaps In The South African HIV Treatment Programme
The data shows mixed results for healthcare providers working on the ground. The number of people starting HIV prevention pills, known as PrEP, dropped from 628,000 to 579,000 over the last year. Furthermore, overall testing numbers stagnated, rising only slightly from 18.6 million to 18.7 million tests.
On a positive note, voluntary medical male circumcisions saw a sharp increase. Figures rose from 258,000 to 418,000 during the same period.
Despite this bright spot, the Department of Health’s ambitious "Close the Gap" campaign is missing its marks. Launched in February 2025, the initiative aimed to put an additional 1.1 million people on treatment by the end of the year. Instead, the programme fell short by roughly 800,000 patients. The major milestone of reaching seven million people on treatment is now unlikely to occur for several years.
The Critical Challenge Of Patient Retention
The core business challenge for the healthcare sector is not initiating treatment, but maintaining it. The Thembisa model reveals a volatile cycle of patients moving in and out of clinical care.
Over the 2024/25 period, more than 700,000 people restarted HIV treatment. Meanwhile, another 180,000 individuals began ART for the very first time. However, nearly the same total volume of patients stopped taking their medication during the year. This high drop-out rate explains the dismal net increase of only 40,000 patients.
Healthcare executives and public health officials have long warned about the dangers of treatment interruption. Patients who cycle out of care face a much higher risk of clinical illness. They also drive up rates of drug resistance and ongoing community transmission.
Mixed Progress Toward Global Healthcare Targets
Despite these systemic bottlenecks, South Africa's performance against the UNAIDS 95-95-95 targets remains highly uneven. The international framework dictates that 95% of people living with HIV should know their status. Then, 95% of those diagnosed should receive treatment. Finally, 95% of those on treatment must achieve viral suppression.
The country successfully exceeded the first target, diagnosing 96% of people living with HIV by 2025. It also met the third target, achieving a 95% viral suppression rate among those actively treated.
However, the middle pillar remains a significant failure. Only 82% of diagnosed individuals were actively receiving treatment in 2025. This leaves South Africa far below the global benchmark and underscores a critical gap in patient retention that the healthcare industry must urgently address.