South Africa has less than eight years before one of its most important external funding streams for HIV and TB programmes ends. Allocation letters sent in March confirm that the Global Fund to Fight Aids, Tuberculosis and Malaria plans its final grant to South Africa in Grant Cycle 9. This cycle will run from April 2031 to March 2034.
At first glance, this looks manageable. The Global Fund contribution is estimated at only 3–5% of South Africa’s overall HIV budget, based on UNAIDS financial dashboard data. But that headline figure hides the real risk. The funding has been heavily concentrated in services for “key populations” who face a far higher risk of acquiring HIV.
HIV Funding: Final Global Fund Grant Date Now Set
The Global Fund provides grants in three-year cycles. South Africa’s second-last allocation, covering 1 April 2028 to 31 March 2031, is just under $345 million for HIV programmes. That is roughly a quarter less than the previous cycle of about $464 million.
The Fund says the shift is strategic. It wants to focus resources on poorer countries with heavier disease burdens. Meanwhile, it also wishes to support countries like South Africa to accelerate towards “self-reliance”.
Sanac CEO Thembisile Xulu says the move is not unexpected. Planning is underway to avoid being caught off guard, especially if the final grant is smaller than in the past.
Why Global Fund HIV Funding Matters Beyond The 3–5%
The biggest exposure sits in key population services. In 2023, Global Fund grants supported 33% of key population programmes, while the South African government funded 15%, and the US government’s PEPFAR funded 52%. With most PEPFAR funding withdrawn in early 2025, the Global Fund has become a main backer of nonprofits providing these services.
These services are not “nice to have”. They are an infection control infrastructure. Programmes aimed at sex workers, gay and bisexual men, transgender people and people who inject drugs reduce onward transmission into wider communities.
In South Africa, around 20% of adults live with HIV. Yet prevalence is far higher in some key groups, including about 62% of sex workers and 63% of transgender women.
HIV Funding: The Business Case For High-Impact Services
Specialised services can cost more. They use mobile clinics, after-hours models, and longer consults. They also address complex needs, such as methadone support for people who inject drugs, which is doctor-prescribed and tightly regulated.
But evidence from health economists shows that a higher impact can outweigh higher unit costs. Where HIV incidence is 3% or more, about 33 people need prevention medication to avert one infection. In lower-incidence settings, around 200 people may be needed to avert one infection.
Local cost modelling cited in the reporting suggests prevention costs per infection averted are substantially lower in key groups than in the general population. That matters for a fiscally constrained system trying to maximise health outcomes per rand.
What Healthcare Leaders Should Watch Next
A 2023 Department of Health plan to integrate key population services into public clinics has reportedly not yet been approved. Meanwhile, implementers are shifting from running parallel services to training and supporting public sector staff.
The risk is timing. If integration lags while donor funding declines, programmes may shrink, patients may disengage, and new infections may rise. Several experts warn that the consequences could become visible within five years.