Progress Against HIV Stalls in South Africa, Research Shows

**Lead**

A raft of recent studies has delivered a sobering message: the decades-long progress in reducing the incidence of HIV in South Africa appears to have stalled. Researchers from leading institutions have analysed national surveillance data and community-based surveys, concluding that the rate of new infections is no longer falling at the pace required to meet the UNAIDS 2030 elimination goals. The findings come as a blow to public health officials and international donors who have invested billions of pounds in the country’s antiretroviral programme, one of the largest in the world.

**Context**

South Africa has long borne the heaviest burden of the HIV epidemic, with an estimated 7.8 million people living with the virus. Over the past two decades, a massive scale-up of antiretroviral therapy (ART) and prevention-of-mother-to-child transmission services dramatically reduced AIDS-related deaths and new infections. However, the latest research, published in peer-reviewed journals and presented at international conferences, suggests that the momentum has slowed. While the number of people on ART continues to grow, the rate at which new infections are occurring has remained stubbornly static for the past several years. This plateau is particularly pronounced among young women and adolescent girls, who account for a disproportionate share of new cases.

The reasons for this stall are multifaceted. Prevention efforts, including pre-exposure prophylaxis (PrEP) and condom distribution, have not been adequately scaled or sustained. Stigma and discrimination remain significant barriers to testing and treatment adherence, especially in rural areas and among key populations. Furthermore, the COVID-19 pandemic severely disrupted HIV services, causing temporary closures of clinics and redeployment of healthcare workers. Although services have largely recovered, the knock-on effects on testing and treatment initiation may still be feeding through into the current data.

**Analysis**

For the United Kingdom, which has been a major bilateral donor to South Africa’s HIV response through the Foreign, Commonwealth & Development Office and its partnership with programmes such as the Global Fund, this development carries substantial implications. British taxpayers have contributed hundreds of millions of pounds to the fight against HIV in southern Africa. A stalling of progress not only threatens the value of that investment but also jeopardises the global goal of ending AIDS as a public health threat by 2030. If South Africa, the epicentre of the epidemic, cannot break the plateau, then the rest of sub-Saharan Africa may also find its gains sliding backward.

Moreover, the emergence of drug-resistant strains of HIV, often linked to inconsistent treatment adherence, adds an extra layer of complexity. A plateau in South Africa could lead to a resurgence of infections in neighbouring countries, which import the virus across borders. For the UK’s own public health, while domestic transmission is low, a global failure to control the epidemic increases the risk of new variants emerging that could eventually challenge existing therapies. The scientific community warns that the window of opportunity to maintain the gains of the last decade is narrowing.

The research also highlights the need to shift from a one-size-fits-all approach to more tailored interventions. Young women in South Africa, for instance, face structural vulnerabilities such as gender-based violence, economic inequality, and limited access to education, which directly fuel HIV acquisition. Any successful strategy must address these social determinants, not merely biomedical tools. The UK’s development agencies have begun to integrate such approaches, but the new evidence suggests that the pace and scale must be accelerated significantly.

**Fontes**

- UNAIDS Special Analysis: ‘Danger: New HIV Infections Not Falling Fast Enough’ (UNAIDS, 2025) - South African National Department of Health: Thembisa Model estimates (2024) - Human Sciences Research Council (HSRC): South African National HIV Prevalence, Incidence, Behaviour and Communication Survey (2023) - Published studies in The Lancet HIV and AIDS & Behavior journals (2024–2025) - Reports from the UK Foreign, Commonwealth & Development Office on bilateral health programmes in South Africa