SANAC CSF Statement ahead of World AIDS Day 2025
Issued by the SANAC Civil Society Forum Coordinating Committee and Programme Review Committee
Gains made in South Africa’s HIV and TB responses are at risk if coordination is not improved. As the globe marks World AIDS Day this year on Monday, 1 December 2025, the SANAC Civil Society Forum (SANAC CSF) voices its concerns about the poor financial coordination of the country’s HIV and TB programmes. Whilst we note that resources are limited, we have observed wastages and we call for the realization of efficiencies by all concerned, starting from the Deputy President Paulus Mashatile in his capacity as the Chairperson of SANAC and all Ministers & Deputy Ministers serving on the Inter-Ministerial Committee (IMC) on SANAC.
To end HIV and TB as public health threats by 2030, it means we need to all recalibrate and that starts at the top. This injunction also needs an agile SANAC Civil Society Forum and SANAC Private Sector Forum to play their roles effectively as they work with government and communities.
In line with the 2025 World AIDS Day global theme of “Overcoming disruption, transforming the AIDS response” and the South African theme of “Renewed effort and sustainable commitment to end HIV”, the SANAC CSF notes that the coordination of finances geared towards navigating South Africa’s HIV and TB response remains a massive concern.
We call on the government to urgently implement the transitional arrangements of the National Health Insurance (NHI) reforms which prioritise the strengthening of district health services. We call on the Minister of Finance, Mr. Enoch Godongwana to stop grandstanding and comply with the requirements on his side to finance the NHI. If Minister Godongwana wants to run South Africa as his backyard, President Ramaphosa must remove him and replace him with a Minister willing to do the right things. A defiant Minister is a danger to the nation. The Minister has stated that he would not remove medical scheme tax credits because doing so “would be an attack on the middle class”. This is an attack on the people of South Africa whose electoral mandate was expressed through President Ramaphosa accenting and signing the NHI into law in 2024 after a 30-year battle. President Ramaphosa was not voted by the middle-class, he was voted by the people of South Africa.
Fixing the finances to respond to HIV and TB is critical as the bulk of HIV and TB services are delivered at district level and if efficiently utilised, these resources will have the greatest impact.
Political leadership requires astute administrative support. Administrators must do their job which they get paid to do. We do not need another commission of inquiry to investigate the levels of corruption and ineptitude that administrators bring to the table whilst people’s right to access health is compromised daily.
We further call on the government as the implementing agency to provide quality healthcare to everyone despite their financial situation to optimise use of existing resources towards existing priorities.
We call on the SANAC Secretariat to take its role as the national AIDS and TB coordinating body by stepping forward to ensure that the NSP objectives are realized. Poor coordination means accountability is out the window. SANAC is not an events agency for World AIDS Day, World TB Day and other events that happen from time to time – it is a Cabinet mandated platform that must bring ALL role-players to act in tandem to address HIV, TB and STIs with agility and without fear or favour. This calls on the SANAC Trust to provide proper governance to the best of its ability. Deputy President Mashatile must conduct a deep stick dive into the affairs of SANAC Trust to ensure efficiencies are realised. Afterall, the Deputy President is not a ceremonial Chairperson of the Council, he is a political leader that must serve the nation and contribute towards ending HIV and TB.
We further call on the private sector to step up to support the national HIV and TB programme. The private sector is a beneficiary of contracts from government for provision of health goods & services and yet they remain the smallest investor in responding to HIV, TB and STIs. It cannot be business as usual. The Private Sector Forum wants to be part of the leadership of SANAC structures – the question is what have they done thus far to contribute to ending the scourge of HIV, TB and STIs? Just two weeks ago, when South Africa hosted the 8th Replenishment of the Global Fund on Malaria, TB & HIV, the Private Sector in South Africa dismally failed to make pledges as a show of their commitment to the health calamity of our lifetime. Words must be met by action.
SANAC CSF Chairperson Solly Nduku notes that “We call on government to act with urgency, courage, and accountability. To invest decisively in a strong, equitable health system. To fully resource National Strategic Plan on HIV, TB and STIs 2023 – 2028 so that it is fully implemented. To end the inequalities that fuel HIV, TB and STIs means we must all place communities at the centre of the response.”
The current geo-political developments should be a wake-up call that our HIV and TB challenge require that we must do things differently to win. We must move with speed to turn the corner. The world is a different place, and it needs men and women ready to make giant leaps to end HIV and TB. Time for wastage, for corruption, for keeping quiet, for inaction, for ineptitude, for grandstanding is over. Those who don’t want to be bullied like us must not act like spoilt brats. We must be people whose words are their bonds.
As he concludes, Solly Nduku adds “Lives are being lost, infections continue and South Africa cannot afford inaction. It is time for bold political will, transparent leadership, and immediate action to deliver a healthier, safer and more just future for all.”
In our quest to work towards a resilient health system in South Africa focused on delivering health services to those who need it the most, one of our key obligations is to ensure that the 6 million people who rely on anti-retroviral drugs remain on treatment. Additionally, we hope to initiate all people (known positives and newly diagnosed) on treatment to end HIV as a public health threat through the continuation of the Close the Gap campaign. The continuation of the campaign must reflect lessons on how to achieve success with all hands-on deck and not cutting corners that we observed which has resulted in the target to reach 1.1 million not being achieved. It is when corners are cut that we see wastage and inefficiencies that result in poor health outcomes and financial wastage.
For TB, South Africa’s obligation is to improve its testing capability to ensure that the more than 60000 people missed by the health system each year are found and initiated onto TB treatment.
According to the World Health Organisation’s Global TB Report for 2025, there has been a decline in the number of people who have fallen ill from TB and those who have died from the curable disease. The report notes that around 54000 people died of TB in South Africa in 2024 while 249000 people fell ill with TB in 2024, compared to 270000 in 2023. This is a calamity of the highest proportions. We must do to TB what we did to COVID-19 so that we don’t see deaths from TB because TB is a curable disease.
The USA was supporting South Africa with its resources. In January 2025, the USA announced a series of financial cuts that have come as a result of the USAID funding freeze across the world. These have resulted in various challenges for the implementation of the country’s National Strategic Plan for HIV, TB and STIs. This was a wake-up call that we were too comfortable to the extent that a large part of our internal problem was placed at the doorstep of another country. When the cuts were announced, we were unprepared and were never ready. We need to think and act differently lest we collectively fail the people of South Africa and delivering them to death because of our actions and inactions.
In recent weeks, South Africa’s National Treasury has released the Medium-Term Budget Policy Statement (MTBPS) which leaves no room for new spending. No new spending means no new programmes. This is concerning because TB programmes urgently need expansion – from new diagnostics to decentralised care and better treatment literacy. This current context means no new investments, no new posts, and no expansion of services.
These decisions made by government have a direct impact on TB funding, TB services and overall health outcomes.
Whilst we have recorded great strides, we are in a crisis. We can overcome this crisis. It is what we do now that we will be judged upon in 2030. We cannot do anything other than the right things at all times, whether we are watched or not. We must be accountable to enjoy success.
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Issued by the SANAC Civil Society Forum
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For more information, please contact SANAC Nelson Dlamini on:
Email: nelson@sanac.org.za
Mobile: +27787310313
