Breaking Point: Impact of US funding cuts on harm‑reduction services in South Africa

Sudden withdrawals of US funding and a reduction in Global Fund allocations have sharply disrupted harm‑reduction and key‑population HIV prevention services across South Africa. The rapid assessment found dozens of USAID‑funded projects terminated, thousands of frontline posts affected, and interruptions to opioid substitution therapy (OST), needle‑and‑syringe programmes (NSP), HIV testing, ART and PrEP in several high‑burden districts. These service losses, documented in the report, coincide with increased overdose risk and greater barriers to care for people who inject drugs, sex workers and men who have sex with men.  

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The report draws on a rapid country survey (July–September 2025), more than 24 key informant interviews, a client survey (N=278), community‑led monitoring and programme records to triangulate findings. It records both harms and local responses: peer networks redistributed supplies, some municipal COSUP sites continued to operate, and emergency financing measures were mobilised, yet gaps remain. The assessment sets out evidence‑based recommendations, including dedicated Treasury budget lines for harm reduction, integration of OST and NSP into the public health system, replication of COSUP models and protection of prevention funding. 
Read the full report to see the data, methods and recommendations in detail.