Withdrawing the United States (US) president’s Emergency Plan for AIDS Relief (PEPFAR) support in South Africa without effectively transitioning to supported services will lead to an estimated 601 000 HIV-related deaths and 501 000 new infections in the next 10 years.

This was according to a research article co-authored by the University of Cape Town’s (UCT) Professor Linda-Gail Bekker and published in the Annals of Medicine – a peer-reviewed medical journal, also published as an editorial in the South African Medical Journal (SAMJ) this week. Professor Bekker is the director of the Desmond Tutu HIV Centre and the CEO of the Desmond Tutu Health Foundation. She is a globally renowned physician-scientist in the field of HIV and tuberculosis (TB).

The funding freeze was announced in January 2025 at the start of President Donald Trump’s second term in office. It was said to be a 90-day pause on US foreign assistance under the condition of reviewing and aligning global assistance with US interests. But a few days after the announcement, the US State Department ordered a “stop work order” directive – expanding the pause to include a freeze on all foreign aid programmes, including PEPFAR.

This order, Bekker said, will have catastrophic effects, place millions of lives in jeopardy and could completely derail South Africa’s hard-won gains in its fight against HIV/AIDS.

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