On January 30, employees at TB HIV Care received a letter informing them that they’d soon get their last paychecks. The nonprofit organization, working directly with people who use drugs in South Africa, has been forced to halt operations—part of a global freeze imposed on groups receiving United States humanitarian aid.
Some 5,000 people were being served by TB HIV CARE at two harm reduction sites in eastern South Africa—depending on them for access to resources including sterile syringes and medications for opioid use disorder (MOUD).
“I owe my HIV-negative status to their efforts.”
Barend Beukes, 42, who lives in the city of Tshwane in Gauteng province, has relied on groups like TB HIV Care, and others funded by US aid programs, for years. “I owe my HIV-negative status to their efforts,” he told Filter.
He got his first dose of methadone right before the COVID lockdowns. “It has progressively been changing my life ever since. Programs like opioid support therapy have allowed me the semblance of a normal life.”
The two sites include one in Tshwane, which has been serving about 4,000 people, and another in the Ehlanzeni district of Mpumalanga province, serving around 1,000.
“Both sites are now closed, leaving these clients without access to critical harm reduction services,” Klaus Mtshweni,a national leader with the SANAC Civil Society Forum PWUD Sub-sector, told Filter.
People have been directed to public health facilities instead, but most of them don’t offer MOUD. And the shutdown was so abrupt, Mtshweni’s not sure if TB HIV Care had the chance to connect people with the few programs that do.
“The closure of these programs has left a significant gap in harm reduction services, putting the health and safety of people who use drugs at risk,” he said. “Without access to [syringes and MOUD], there is an increased likelihood of HIV and hepatitis C transmission, overdose deaths and other drug-related harms.”
The US spends less than 1 percent of the federal budget on international humanitarian aid. Nonetheless, on January 20 President Donald Trump ordered a 90-day work stoppage to audit how the money is used.
“We spent the weekend feeding USAID into the wood chipper,” billionaire Elon Musk gloated.
Secretary of State Marco Rubio issued a memo exempting “lifesaving” humanitarian efforts, but aid groups quickly found that their stop-work orders were not being reversed. The Trump administration’s attacks on the largest foreign aid agency, USAID—which has been funding TB HIV Care through PEPFAR (President’s Emergency Plan for AIDS Relief)—sharply escalated: Top staffers were fired and the website knocked offline. Almost all USAID staff, including thousands based overseas, are being placed on administrative leave from February 7.
On February 3, Trump seemed to confirm rumors that the agency will be dismantled and what few programs remain will be folded into the State Department. Shutting down USAID, “should have been done a long time ago” he told reporters. On the same day, Rubio announced that he was now the administrator of USAID.
“We spent the weekend feeding USAID into the wood chipper,” billionaire Elon Musk gloated. “Could’ve gone to some great parties. Did that instead.”
Musk’s weekend plans have been presented as a matter of fiscal responsibility, but the administration has made no pretense of hiding its ideological agenda, raging against “DEI” and trans care. Harm reduction, including US-funded international programs, could similarly be categorized, derisively, as “woke.” Trump’s nominee for health secretary, Robert Kennedy Jr., favors 12-step programs and coerced treatment.
Aid groups are frantic, and whatever happens from here, great damage has immediately been done.
“Things have already been disrupted,” Shaun Shelly, executive director of Harm Reduction International, told Filter. “The momentum has been compromised, and it will take a lot to overcome the inertia and restore the services.”
“Many people traumatized and criminalized by the American-led war on drugs, who found employment as peers, have lost their only income and their medical services.”
Shelly, who is South African, is also a co-founder of SANPUD (South African Network of People Who Use Drugs), and previously served as human rights and policy lead for TB HIV Care.
“The reality is that many people who have been traumatized and criminalized by the American-led and -sponsored war on drugs, who found employment as peers in harm reduction programs, have lost their only income and their medical services without notice,” he said.
“Experience and research have shown that disrupted services lead to people dropping out of programs, stopping treatment, and often they end up back on the streets, vulnerable, drug-dependent and retraumatized.”
The shuttering of harm reduction programs also betrays hard-earned trust. “The situation undermines years of progress in building engagement with people who use drugs, who often face stigma and discrimination in public health care settings,” Mtshweni said.
“The broader impact of the stop-work orders on harm reduction efforts in South Africa is deeply concerning,” he added. “It not only disrupts essential services but also sends a discouraging message about the prioritization of harm reduction in public health policy.”
Beukes considers himself lucky to have had past access to harm reduction services, unlike many who now won’t.
“The harsh reality of President Trump’s freeze is that people will never have the opportunity to live a better quality of life,” he said. “The cold hard truth is that for every one of me there are around five others who are not aware of their HIV status, and who desperately need projects that’re funded to ensure dreaded diseases like HIV, TB and hepatitis are under control.”
Photograph by US Navy via Picryl/Public Domain
Correction, February 12: A previous version of this article wrongly attributed some TB HIV CARE services (and prospective layoffs) to SANPUD, which advocates for people who use drugs in South Africa. This is not the case, and we apologize for the error.