The withdrawal of US PEPFAR funding has prompted urgent questions about HIV treatment continuity for vulnerable communities, including people with albinism.
A question hung in the air at a recent gathering in Rio de Janeiro, reported by AllAfrica: "What is the plan before we get back to a stage where we are burying people?"
The person asking was not speaking abstractly. They were speaking about South Africa, and about what happens to HIV treatment programmes when the money that funds them disappears.
The funding that held the system together
For two decades, the US President's Emergency Plan for AIDS Relief — known as PEPFAR — channelled billions of dollars into HIV prevention, testing, and treatment across sub-Saharan Africa. In South Africa alone, AllAfrica reported, PEPFAR supported a significant share of the country's antiretroviral programme, including community health workers, clinic infrastructure, and supply chains that reached people in rural and underserved areas.
The scale of the withdrawal, AllAfrica noted, is not yet fully mapped. What is clear, according to sources cited in the piece, is that gaps are already opening. Community health workers have been told their contracts will not be renewed. Some clinics have begun rationing services.
For people with albinism, the implications run in two directions. The community faces elevated rates of skin cancer — a condition requiring consistent medical monitoring — and many rely on the same overstretched public health infrastructure that PEPFAR helped sustain. Any further erosion of that system narrows access to the dermatological care that people with albinism already struggle to reach.
'What is the plan?'
The question reported by AllAfrica was asked by a civil society delegate attending a global health conference. It was not rhetorical. Those present, the report noted, did not have a clear answer.
South Africa's government has indicated it will seek to absorb some of the shortfall through domestic budget reallocation, AllAfrica reported. Health advocates cited in the piece described that commitment as insufficient given the scale of the gap. $400 million per year was the approximate figure AllAfrica attributed to PEPFAR's direct contribution to South Africa's HIV response — a number the country's own health budget was not structured to replace quickly.
The civil society voices quoted in the report were specific about what they feared: not a dramatic collapse, but a slow erosion. Fewer community health workers means fewer people found, tested, and linked to treatment. Fewer people in treatment means the virus spreads further before it is caught.
For any community already navigating barriers to healthcare — distance, cost, limited specialist knowledge among general practitioners — a system under additional strain is a system less likely to meet their needs.
The question from Rio has no easy answer yet. AllAfrica reported that advocacy groups across the continent are pressing both their own governments and international donors to name a concrete transition plan before the gaps become irreversible.
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