'HIV infections could rise': Scientist warns aid halt could undo past gains

Dr Glenda Gray's work in Human Immunodeficiency Virus (HIV) research has taken centre stage after several South African organisations that support people with HIV found themselves in a state of uncertainty following the US freeze on foreign aid.

Although the US State Department later added a waiver for "lifesaving" aid, the impact has been immediate, placing a strain on vital services and threatening life-saving initiatives. Dr Gray's studies, which have made groundbreaking strides in HIV prevention in South Africa over the years, have been central to the country's fight against the epidemic.

At the heart of this crisis is the largest HIV clinical trial in the region, which spans 15 sites and involves 5,400 participants. This trial, led by Dr Gray, continues to be a cornerstone of South Africa's battle against HIV/AIDS.

In a country where 5.5 million people rely on antiretroviral treatment, the funding uncertainty has become a massive concern. Recently, a federal judge in the US ruled that the Trump administration must temporarily lift the funding freeze.

Yet, as Dr Gray shared with TRT World's Sadiq Bhat, the uncertainty is far from over. There's still the looming fear that without continued support, patients may miss treatment, HIV infection rates may rise, and ultimately, more lives could be lost.

Sadiq Bhat — Why is South Africa still under a stop-work order despite new orders lifting the USAID funding freeze?

Dr Glenda Gray — On Friday (last week), I reached out to my programme officer at United States Agency for International Development (USAID), seeking clarity on the next steps.

Given the recent court rulings, I inquired whether the suspension on our cooperative agreement should now be lifted in compliance with the order.

They stated that guidance would be forthcoming, though no concrete instructions have been provided yet.

For now, it appears that the distribution of HIV medication will resume, but the long-term outlook remains uncertain.

There are real concerns that if the freeze on funding continues, infections could rise not just in South Africa but across other affected countries as well.

In South Africa, the government has been covering the cost of medications, yet the broader situation remains unclear.

As it stands, no implementers in the country have received anything beyond the initial notice of the temporary restraining order, with USAID stating that further guidance will be provided as soon as possible.

Crucially, no formal letter has been issued to lift the stop-work order for South Africa, leaving programmes in limbo.

SB — If the US president's Emergency Plan for AIDS Relief (or PEPFAR) saves millions of lives, why is South Africa still left in limbo?

GG — At this moment, it appears that the stop-work order remains in place for South Africa, despite the court ruling lifting the USAID funding freeze.

This is particularly striking given the immense impact of PEPFAR since its launch in 2003. By rough estimates, the programme has saved around 25 million lives globally.

In the early days, we were working in Soweto at the Perinatal HIV Research Unit, one of the first beneficiaries of PEPFAR. At that time, the funding was truly life-saving — we were able to put 100 people a day on antiretroviral treatment.

Within six months, we saw a dramatic transformation: patients who had arrived in wheelchairs or on oxygen were recovering, the drips stopped, and children who had been too ill to move were returning to school.

I've seen firsthand how PEPFAR breathed life into South Africa's most vulnerable communities.

That's why the current uncertainty is so troubling — without immediate action, the progress of the past two decades is at risk.

SB — Is South Africa investing in vaccine reserach?

GG — Global partnerships have long played a crucial role in vaccine development, but shifting geopolitical dynamics are now impacting HIV research in Africa. In South Africa, the government — through the South African Medical Research Council and the Department of Science and Innovation — has invested in vaccine research.

However, this funding has largely been limited to the pre-clinical stage, falling far short of what is needed to conduct large-scale clinical trials.

Without substantial global collaboration, African nations simply lack the research and development (R&D) funding available in the US and Europe. While international support remains vital, there is also an urgent need for African governments to step up their investment in vaccine R&D.

The African Union, in particular, must push for greater contributions from member states to close this funding gap and ensure that progress in HIV research is not stalled by financial constraints.

SB — With US funding driving global HIV vaccine research, what happens if this investment starts to fade?

GG — Developing an HIV vaccine requires significant funding, far beyond what any single country can provide. A truly global effort is therefore essential.

The US, through the National Institutes of Health (or NIH) and USAID, has played a crucial role in supporting vaccine research — not just for American scientists, but also for South African and European researchers. Their investment in R&D has been invaluable, and there is deep gratitude for this contribution.

However, this kind of sustained investment must continue, as it benefits not only African scientists but also American academic institutions.

Leading HIV vaccine research hubs, such as Duke University, Harvard, Fred Hutch, Rockefeller and Scripps, all gain from US government funding that advances vaccine development both domestically and internationally.

The progress of global health science depends on maintaining and expanding this commitment.

SB — What steps must be taken to secure ongoing funding for HIV vaccine R&D amid uncertainties?

GG — To ensure the continuity of critical HIV vaccine research, both policy and scientific efforts must align. At the global level, it is vital that governments, particularly in the US, recognise the immense value of investing in vaccine R&D.

Not only does this drive progress for HIV, but it also advances the development of vaccines for other diseases like TB and cancer, thereby improving global health.