The impact of a flourish of the US president's pen in Washington a year ago continues to be felt on individual lives some 13,000km (8,000 miles) away in South Africa. There was a collective gulp among some in the health sector here when, hours after he was inaugurated, President Donald Trump signed an executive order freezing US aid commitments. For South Africa, that meant the potential loss of an estimated $400m (£295m) that the US contributed each year to the country's HIV programmes – representing about a fifth of what it was spending on the issue. Last year, the government provided $46m in response to the US decision - just 11.5% of what was lost. The US also agreed a 'bridge plan' of $115m that will last until the end of March in place of regular funding from the US President's Emergency Fund for Aids Relief (Pepfar).
Since being set up by President George W Bush in 2003, the US government has invested over $110bn in the global HIV-Aids response through Pepfar, saving 26 million lives, according to the state department. Many of those lives were in South Africa as around 13% of the population are living with HIV, making it the country with the largest number of HIV-positive people in the world.
Enormous advances in treatment and prevention over the decades have ensured many are alive who would not be otherwise but these are expensive and the loss of funding could put many at risk. Prof Linda-Gail Bekker, the head and co-founder of the Desmond Tutu Health Foundation and one of the world's top HIV researchers, says there is no doubt there has been a reduction in testing and gaps in services.
The South African government has mobilized some emergency funding, but it was really a drop in the ocean compared to what has been lost. Among other services, the Tutu Foundation uses its money to fund mobile clinics for people unable or unwilling to go to government-funded ones. On a bright summer day, a small group of women gather outside one of their mobile clinics in Philippi, one of Cape Town's most dangerous townships, listening intently as a health worker lists different types of preventative HIV medication.
The mobile clinics are significant in providing both critical services and a safe space for young people to discuss their health without stigma. However, as funding continues to decline, experts worry many preventive programs and treatments may become inaccessible, leading to increased rates of new infections, echoing concerns about the health and future of millions of South Africans affected by HIV.
Since being set up by President George W Bush in 2003, the US government has invested over $110bn in the global HIV-Aids response through Pepfar, saving 26 million lives, according to the state department. Many of those lives were in South Africa as around 13% of the population are living with HIV, making it the country with the largest number of HIV-positive people in the world.
Enormous advances in treatment and prevention over the decades have ensured many are alive who would not be otherwise but these are expensive and the loss of funding could put many at risk. Prof Linda-Gail Bekker, the head and co-founder of the Desmond Tutu Health Foundation and one of the world's top HIV researchers, says there is no doubt there has been a reduction in testing and gaps in services.
The South African government has mobilized some emergency funding, but it was really a drop in the ocean compared to what has been lost. Among other services, the Tutu Foundation uses its money to fund mobile clinics for people unable or unwilling to go to government-funded ones. On a bright summer day, a small group of women gather outside one of their mobile clinics in Philippi, one of Cape Town's most dangerous townships, listening intently as a health worker lists different types of preventative HIV medication.
The mobile clinics are significant in providing both critical services and a safe space for young people to discuss their health without stigma. However, as funding continues to decline, experts worry many preventive programs and treatments may become inaccessible, leading to increased rates of new infections, echoing concerns about the health and future of millions of South Africans affected by HIV.
