OPINION | People with disabilities hardest hit by US aid cuts

The abrupt suspension in early 2025 of Pepfar (the US president’s emergency plan for Aids relief), after a halt in US foreign aid, has dealt a severe blow to SA’s HIV response.

Among the hardest hit are people living with disabilities, many of whom depend on community-based health services for care and support.

Yet, despite this negative effect, disability has been noticeably absent from public discourse and policy debates concerning the funding cuts.

The UN Convention on the Rights of People with Disabilities describes a person living with a disability as someone who has long-term problems with their physical, mental, intellectual or sensory abilities that, along with other problems, make it hard for them to fully participate in society.

A recent study by Stats SA states that about 3.3-million people or about 6.0% of the population, are considered to be living with a disability as per the UN definition.

A broader definition of disability estimates that this figure stands at 15.7%.  The UN convention states that policies that include everyone are necessary for people living with disabilities to be able to exercise their rights.

In many post-war African countries, people living with disabilities are often pushed to the edges of society. When it comes to making disability policies in Africa, there is a clear and noticeable gap between the rights of people living with disabilities and the promises of inclusion made when the Convention on the Rights of People with Disabilities was ratified.

This gap is especially clear when looking at how its ideas are put into practice during policymaking and implementation processes. There is strong evidence that people living with disabilities have been intentionally kept from taking part in making and enforcing disability policy and practice, particularly in developing countries. 

SA already has a high rate of gender-based violence (GBV) in the form of domestic partner violence among other forms. Research indicates that a woman in Gauteng has a one-in-four chance of experiencing GBV in the home and outside.

A 2021 Stats SA study found that one in five women have been physically abused by a male partner. 

 According to research, women living with disabilities, particularly black women, are more likely to be hurt by their partners or to experience GBV compared to their able-bodied peers.

There are big differences in how much black women earn in comparison with men or white women. As an outcome, most black women living with disabilities are impoverished and therefore require more help with money and basic services. 

Their identity makes them vulnerable to violence in the form of intimate partner abuse. They are more likely to be sexually abused or neglected than their male counterparts living with disabilities.

This is because society sees them as helpless and they often have to rely on their abusers, making them more susceptible to experience rape, unwanted pregnancies and sexually transmitted infections.

SA’s HIV initiatives, especially those of community-based NGOs, received about 17% to 20% of the Pepfar financing.

People living with disabilities, who depend on accessible, outreach-based models, were disproportionately affected by interruptions in services such as antiretroviral therapy, pre-exposure prophylaxis, HIV testing and gender-affirming treatment.

And in the aftermath of the funding cut there has been no immediate plan to fill the gap in disability-sensitive health care.

The withdrawal of funding has not only pushed back goals for HIV treatment, but has also made it harder for people living with disabilities and other neglected groups to get help.

Without community-level services that are easy to access, many people must deal with centres that are understaffed and not easy to get to or to go to without necessary care.

Despite this reality, media coverage has largely focused on infection rates and treatment outcomes, while overlooking the disproportionate effect on people living with disabilities, many of whom face persistent barriers related to transportation, communication, and inaccessible infrastructure.

Dr Kudzaiishe Vanyoro is a research fellow at the Institute for Pan African Thought and Conversation