TAC demands action to fix clinic crisis

The Treatment Action Campaign (TAC) has used World AIDS Day 2025 to call on the South African government to urgently address severe challenges in public clinics and accelerate the rollout of six month antiretroviral (ARV) refills. TAC said these steps are essential if the country is to meet its goal of getting 1.1 million more people living with HIV on treatment.

The appeal follows the government's February 2025 pledge to increase treatment uptake after data showed South Africa lagging behind global targets to ensure that 95 percent of people diagnosed with HIV are on ARVs. TAC has since been supporting the “Close the Gap” campaign to bring people back into HIV care.

TAC’s Daniel Mathebula said thousands of people had returned to facilities to restart treatment, but warned that poor conditions at clinics continued to push people away from care. TAC argues that existing systemic failures must be fixed or the gains made will not be sustained.

A new Ritshidze World AIDS Day report, released on Monday, documents extensive challenges in the public health system. It draws on data from 33,819 patients surveyed between October and November 2025 across 360 facilities in 19 districts in seven provinces. The findings provide a snapshot of the country’s HIV response nearly a year after major United States funding cuts resulting in reduced PEPFAR support.

The report highlights widespread staffing shortages, with 82 percent of monitored facilities reporting critical staff gaps. More than half of the facilities said their capacity had declined since January. Long waiting times remained common, especially in Bojanala, Lejweleputswa, Mangaung, Thabo Mofutsanyana, Buffalo City, the City of Tshwane, and Capricorn. Some districts, including Mopani and Sedibeng, saw further deterioration after the PEPFAR disruptions.

Clinic filing systems were found to be a major cause of delays. Up to 90 percent of facilities in Mangaung and similarly high percentages in other metros reported poor record management, resulting in long waits for patient files. Forty three percent of people surveyed said finding their files contributed to extended waiting times.

On ARV supply, 13 percent more people reported receiving a three month refill compared to mid 2025, but fewer than 60 percent did so in several districts including Mangaung and Bojanala. eThekwini continued to have high reports of one month refills. Although fewer facilities reported HIV testing challenges, only 63 percent of people not on ART said they were offered a test.

Ritshidze also recorded ongoing concerns about unfriendly services. Reports of staff shouting at patients increased, and many people living with HIV, sex workers, drug users, and LGBTQIA+ individuals reported hostile treatment. Denial of services also increased, with 464 people reporting refusals due to missing transfer letters and 777 reporting denial due to lack of ID.

TAC and Ritshidze argue that longer ARV refills would reduce clinic visits and help more people to remain on treatment. Although the government committed in 2024 to ensuring at least 30 percent of eligible patients receive six month refills by mid 2025, progress has been slow. By the end of October 2025, fewer than 25,000 people had been enrolled, despite a target of 200,000 by March 2026. Limpopo had not begun rolling out a six month supply at all.

TAC’s leadership called on the Deputy President and the Minister of Health to ensure provinces address staffing shortages, reduce waiting times, end denial of services, and accelerate six month ARV refills. The organisation said provincial departments must be held accountable for fixing clinic conditions to ensure more people start and remain on treatment.