The Treatment Action Campaign (TAC) has criticised the South African government for failing to address deteriorating conditions in public clinics and for the slow rollout of six-month antiretroviral (ARV) refills — warning that these shortcomings are driving people out of the health system and threatening the country’s HIV response.
TAC says key populations — including sex workers, people who use drugs, and trans and queer communities — remain among those at highest risk. Yet poor clinic conditions continue to obstruct access to both HIV prevention and treatment services.The organisation also cautioned that scientific breakthroughs, such as the new six-monthly HIV-prevention injection lenacapavir, will have little impact unless government reforms patent laws to ensure affordability and enables future local production of generic versions. According to TAC, ongoing system failures are deterring people from HIV testing, treatment initiation, and long-term adherence to ARVs — ultimately undermining the goals of the national Close the Gap campaign.
Six-Month ARV Refills: Rollout “Far Too Slow”
TAC and fellow civil-society coalition Ritshidze have long advocated for nationwide six-month ARV refills for all eligible, clinically stable individuals. Evidence from other countries has shown that longer refills improve treatment retention and reduce unnecessary clinic visits. Despite a high-level commitment made last World AIDS Day by the Minister of Health and the Deputy President, progress remains sluggish.
While initial expectations were to reach 750,000 to one million people by mid-2025, the current national target has been drastically reduced to only 200,000 people by March 2026. By the end of October, fewer than 25,000 people had been enrolled. “We are extremely concerned about the slow progress on enrolling people on six-month supply. Only letting 10 facilities per province start is inequitable and far too slow,” said TAC’s Ndivhuwo Rambau.
TAC also flagged Limpopo as the only province yet to begin the rollout. “All clinics that want to give six-month supply should be able to start right away, in all provinces including Limpopo,” Rambau added.
‘Fix Our Clinics, Save Lives’: TAC Calls for Accountability
TAC General Secretary Anele Yawa urged national leadership to intervene directly and hold provincial and district health departments accountable.“This World AIDS Day we are calling for the Deputy President and Minister of Health to take leadership and hold provinces accountable to actually fix the crisis in our health system,” Yawa said.
He stressed that Ritshidze’s clinic-monitoring reports should be used as an early-warning system to identify health-system failures — yet some provinces have ignored them. “The Free State engaged with our findings and developed action plans, but others like Limpopo ignored our efforts,” he said. Yawa emphasised the need for meaningful commitment across all provinces to reduce waiting times, stop turning patients away due to missing documents, and ensure non-discriminatory access for key populations.
He also urged government to urgently address staffing shortages, which have worsened following recent US funding cuts that led to the loss of thousands of healthcare workers. “If government is serious about getting 1.1 million people to start or restart treatment, then commitments must be visible in clinics — not just on paper,” Yawa said.
