US budget cuts have hit South Africa's fight against HIV hard. Since President Donald Trump froze US aid, South Africa lost about $400 million annually from the US for HIV programs. This was nearly 20% of the country’s HIV budget. The South African government managed emergency funding of only $46 million last year and a bridge plan of $115 million will continue until March. US investment through PEPFAR has saved millions of lives since 2003 but now the funding drop threatens progress. Around 13% of South Africans live with HIV, the highest globally. Professor Linda-Gail Bekker, head of the Desmond Tutu Health Foundation, said the loss led to reduced HIV testing and service gaps. “Forty per cent of my funding, about $8 million, came from the US government,” she said. Mobile clinics that reach hard-to-access communities remain open thanks to some funds but many charities have closed. Women in Cape Town’s dangerous Philippi township rely on these clinics for preventive HIV treatment like injectable CAB-LA, which cuts infection risk by 80%. Twenty-eight-year-old Esethu said, “The mobile clinics are very helpful because you don’t have to walk much or spend money on taxis.” Nineteen-year-old Okuhle fears losing these clinics will increase HIV risk among youth. South Africa’s Health Minister Dr Aaron Motsoaledi hopes to boost domestic HIV funding soon and is seeking other donors. The Global Fund has secured 900,000 doses of a new prevention drug, Lenacapavir, coming soon. Experts warn millions will need this to curb new infections, which hit 180,000 last year. Professor Helen Rees from Wits RHI calls the US funding cuts “profound” and warns that stopping testing and prevention will raise HIV cases. Data collection to track the epidemic has also been hurt, making it harder to respond effectively. Motsoaledi says there’s little chance US funding will return, pointing to America’s new “America First Global Health Strategy.” Experts stress ending HIV in South Africa is key to ending the epidemic worldwide. The future hinges on continued support for treatment, prevention, and research in this heavily affected nation.