'My fear is mortality is going to be very high'

Cuts in US funding have hit HIV programmes to jeopardise research and expose those living with the virus to greater risk

- By Nick Dall

Zola Madikane* was born HIV positive in 2004. Put on antiretrovirals (ARVs) as a baby, she has been on the life-saving medication ever since and has lived a normal life. No longer.

For most of her life her viral load (the amount of HIV in her blood) has been undetectable. “When I went for my February clinic visit, I didn’t get my pills,” she said. “They told me ‘shortage of staff’ and ‘come back another day’. I came back a few times, but it was the same story.”

Madikane, who is seven months pregnant, finally managed to get a batch of ARVs in mid-May but by then her viral load was sky high. “It has never been high like this,” she said. “It is too risky for my unborn baby.” The risk of transmitting the virus to her child during delivery or while breastfeeding is much higher if her HIV is detectable. “I don’t want my boy to be positive.”

Sister Sibongile Mqaba, who has worked in the same clinic in Cape Town for 32 years, is hopeful that Madikane will get her viral load down before she delivers. But Madikane is not the only patient struggling to get treatment since the suspension of most President’s Emergency Plan for Aids Relief (Pepfar) funding to South Africa. Since initial cuts in January, US president Donald Trump has made further significant reductions.

South Africa’s health minister, Aaron Motsoaledi, has complicated matters by insisting that the country’s HIV programme is “not collapsing” and assuring the public that there is no shortage of ARVs.