In February 2025, the South African government launched the Close the Gap campaign, an ambitious initiative aimed at bridging disparities in HIV/AIDS treatment and ensuring universal ART (antiretroviral therapy) access. With South Africa carrying the world’s highest HIV burden—over 7.8 million people living with the virus—the urgency of this campaign cannot be overstated. However, behind the rhetoric of progress lies a deeper reality: Close the Gap is as much a political move as it is a public health intervention. It comes at a time when international funding, particularly from the United States through the President’s Emergency Plan for AIDS Relief (PEPFAR), is in decline, leaving South Africa to grapple with an increasingly precarious HIV/AIDS response.
This article critically examines whether Close the Gap is a genuine step towards health sovereignty or a short-term fix masking deeper structural dependency. By tracing South Africa’s HIV/AIDS policies from Mbeki’s denialism to Ramaphosa’s pragmatism, we analyse the domestic political calculations behind this campaign. Further, we interrogate whether South Africa can truly achieve health independence without Western aid, looking at alternatives such as BRICS partnerships and integrating Traditional Health Practitioners (THPs) into ART programs.
I. The Western Lifeline: How U.S. Funding Shaped South Africa’s HIV/AIDS Response
Since the early 2000s, PEPFAR has been a cornerstone of South Africa’s HIV/AIDS response, providing billions in funding to expand ART access. PEPFAR has saved millions of lives, but its financial support has not come without conditions. U.S. funding has dictated South Africa’s health policies, influencing everything from ART distribution to abstinence-focused sexual education campaigns. The presence of American NGOs has further entrenched Western control over HIV/AIDS programming, reinforcing a model where Africa is still dependent on external actors for essential healthcare services.
Recent shifts in U.S. policy, however, expose the dangers of such dependence. Under the Trump administration, global health aid faced significant cuts, signalling a move away from sustained HIV/AIDS funding. While the Biden administration initially restored some commitments, Republican-controlled congressional efforts to scale back PEPFAR in 2024 reignited concerns. South Africa now finds itself in a precarious position: an effective ART program built on external funding that is increasingly unstable. Close the Gap emerges in this context—not necessarily as a proactive step forward, but as a response to the reality that Western support is diminishing.
II. South Africa’s Political Leadership and the HIV/AIDS Crisis: From Denialism to Pragmatism
South Africa’s history with HIV/AIDS is deeply political. Under President Thabo Mbeki (1999-2008), the government infamously denied the link between HIV and AIDS, delaying ART rollout and costing an estimated 330,000 lives. Mbeki’s administration, influenced by conspiracy theories and skepticism of Western medicine, rejected proven treatments in favour of alternative remedies such as garlic and beetroot. This era not only damaged South Africa’s public health response but also entrenched the state’s distrust of biomedical interventions.
Jacob Zuma’s presidency (2009-2018) marked a dramatic policy shift. Under his administration, South Africa expanded ART coverage significantly, benefiting from renewed international funding, particularly from PEPFAR and the Global Fund. However, this progress was accompanied by continued reliance on Western donors, making the country’s HIV/AIDS program financially vulnerable.
A technocratic, public-health-driven model has characterised president Cyril Ramaphosa’s approach. While his government has committed to universal ART access, the financial realities of donor dependency remain unresolved. Close the Gap is framed as a bold initiative to achieve ART sustainability, but given the declining availability of Western funds, it may also be a necessary political manoeuvre aimed at demonstrating self-reliance ahead of South Africa’s 2024 elections.
III. The Political Calculations Behind “Close the Gap”
At its core, Close the Gap is not just about HIV/AIDS treatment—it is about political legitimacy. The South African government is facing increasing pressure to show that it can sustain its ART program without being beholden to Western donors. The campaign allows Ramaphosa’s administration to position itself as proactive in ensuring universal treatment while preemptively responding to potential donor pullouts.
However, questions remain about whether this initiative is financially practical. The South African health sector is already under strain, with economic downturns limiting government spending. Can Close the Gap succeed without alternative funding models? And crucially, is it a genuine attempt at health sovereignty, or merely a stopgap measure designed to maintain political stability?
Grassroots movements, particularly the Treatment Action Campaign (TAC), have historically played a key role in holding the government accountable for HIV/AIDS treatment. However, in recent years, their influence has waned. Civil society organisations must once again step up to ensure that Close the Gap does not become an empty political slogan but a meaningful, sustainable intervention.
IV. Can South Africa Achieve Health Sovereignty Without the West?
If Close the Gap is to be more than a temporary fix, South Africa must address the structural issues underpinning its ART dependency. One potential solution lies in pharmaceutical production. South African-based companies such as Aspen Pharmacare have made strides in producing generic ARVs, but intellectual property laws and Western pharmaceutical monopolies continue to restrict large-scale domestic production.
Another avenue is South-South cooperation, particularly through BRICS (Brazil, Russia, India, China, and South Africa). Brazil and India, for instance, have developed robust generic drug industries, challenging Western pharmaceutical hegemony. If South Africa strengthens ties with these nations, it could secure alternative sources of ARVs, reducing its reliance on Western donors. However, geopolitical tensions and logistical challenges may limit the feasibility of such collaborations.
Beyond pharmaceutical production, South Africa must also rethink its approach to health knowledge. The continued marginalisation of Traditional Health Practitioners (THPs) reflects the dominance of Western biomedical frameworks. Yet millions of South Africans rely on traditional medicine, including herbal treatments for HIV/AIDS-related symptoms. Integrating THPs into ART programs could create a hybrid health model that is both accessible and culturally relevant. While this would require rigorous scientific validation, it presents a radical alternative to the pharmaceutical-driven, Western-dominated model of HIV/AIDS care.
Radical African Alternatives: Opposing the Western Approach and Biomedicine in Favour of Indigenous Knowledge and Traditional Health Practitioners (THPs)
While the Western biomedical approach to HIV/AIDS has undoubtedly contributed to life-saving treatments, a more radical and culturally rooted response—grounded in African knowledge systems—has gained traction in some African countries. The incorporation of Traditional Health Practitioners (THPs) into national health frameworks presents a promising alternative, moving away from the biomedical model imposed by Western systems. This is not merely symbolic but offers a holistic, integrated approach that bridges Indigenous knowledge with contemporary healthcare practices.
In several countries across Africa, the integration of traditional medicine has been explored with varying degrees of success. For instance, in Botswana, the government has increasingly recognised the role of THPs in providing complementary care for HIV-positive individuals. According to a 2019 study, 62% of rural South Africans seek traditional medicine before or alongside biomedical treatments, demonstrating a strong preference for practices that are culturally and socially embedded in local communities. This highlights a significant gap in the Western biomedical framework, which often fails to consider the social and cultural contexts of health.
1. Complementary Medicine in Uganda: A Successful Model
Uganda’s approach to integrating traditional medicine into its health system is one example of a successful model. The Ugandan Ministry of Health has worked to establish a regulatory framework that recognises THPs as legitimate contributors to healthcare, especially in HIV/AIDS treatment. The Uganda National Policy on Traditional Medicine was created in 2001 to formalise this integration, setting guidelines for the use of herbal remedies in treating various diseases, including HIV/AIDS.
In Uganda, several THPs have been trained to work alongside healthcare professionals, providing complementary treatments to ART. According to research from the Uganda Traditional and Complementary Medicine Development Institute (2017), THPs in Uganda have demonstrated positive impacts on patient adherence to ART, with over 80% of patients reporting improved health outcomes when combining traditional medicine with ART. The integration of herbal treatments, like Senna, Bitter leaf, and Andrographis paniculata, with ART has contributed to immune system strengthening and better overall health management, showing a promising synergy between Indigenous and biomedical treatments.
2. South Africa: Integrating THPs in HIV/AIDS Treatment
In South Africa, where the HIV/AIDS epidemic has hit hardest, the role of THPs in healthcare has been gaining recognition. Although South Africa’s health system remains heavily reliant on biomedical approaches, there is a growing movement to incorporate traditional medicine into mainstream treatment. The South African Traditional Health Practitioners Act of 2007 legally recognises THPs as healthcare providers, allowing them to be officially registered and regulated by the government.
Several research studies and local community health reports have indicated that combining THPs’ herbal treatments with ART improves health outcomes. A 2018 study in KwaZulu-Natal found that HIV-positive patients who used both ART and traditional herbal remedies had a 35% higher rate of sustained viral suppression compared to those relying solely on ART. The THPs in the study used plants like Sutherlandia frutescens, Pelargonium sidoides, and Hoodia, which have demonstrated antiviral properties, aiding in immune system enhancement and reducing ART side effects.
Furthermore, the South African Department of Health, through collaborations with traditional healer associations, has been exploring how to integrate THPs more effectively into the HIV/AIDS care continuum. This integration is not only practical but also symbolic acknowledging the cultural importance of traditional medicine while improving the accessibility of care, especially in rural and underserved areas.
3. Zimbabwe: A Pioneering Example of Traditional Medicine Integration
Zimbabwe provides another compelling example of integrating traditional medicine into HIV/AIDS treatment. The country’s Traditional Medical Practitioners’ Council (TMPC) has played a pivotal role in advancing the use of traditional medicine, particularly in HIV/AIDS care. A 2020 study revealed that traditional healers in Zimbabwe, who have deep knowledge of local herbs and plant-based remedies, have been able to treat HIV/AIDS symptoms, particularly in managing opportunistic infections like tuberculosis, which often co-occurs with HIV.
The success of traditional medicine in Zimbabwe can be attributed to the active involvement of THPs in the health system. Collaborations between biomedical and traditional healthcare workers have improved patient retention rates in rural areas, where ART access is limited. A study conducted by the Zimbabwe National Traditional Healers Association found that over 40% of HIV patients in rural areas were more likely to adhere to ART when they also had access to herbal remedies provided by THPs, especially those used to boost the immune system and improve appetite.
4. The Role of THPs in Global Health: Lessons from Other Countries
Looking beyond Africa, other countries have successfully integrated traditional medicine into their public health systems. In China, the integration of traditional Chinese medicine (TCM) with Western biomedical practices has been well established, especially for chronic conditions like HIV/AIDS. Studies show that combining TCM with ART can significantly improve viral suppression and quality of life. Similarly, in India, the Ministry of AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) has supported the use of traditional remedies alongside conventional treatments, particularly for managing chronic diseases like HIV.
These examples from Uganda, South Africa, Zimbabwe, and globally illustrate how integrating traditional medicine can not only complement Western biomedical approaches but can also lead to better health outcomes, particularly in settings where access to modern healthcare is limited. The success of these programs depends on respect for cultural practices, thorough training for THPs, and the establishment of regulatory frameworks that ensure safety and efficacy.
Conclusion: A Crossroads for South Africa’s HIV/AIDS Response
The launch of the Close the Gap campaign marks a pivotal moment in South Africa’s fight against HIV/AIDS. While the campaign reflects a genuine commitment to expanding access to antiretroviral therapy (ART), it also highlights the vulnerabilities of a system that remains heavily dependent on external financial support, particularly from Western donors. South Africa finds itself at a crossroads: will it continue to rely on the uncertainties of foreign aid, or will it chart its own path toward true health sovereignty, one that does not compromise its autonomy?
This turning point demands more than just political rhetoric; it calls for bold, structural reforms. The South African government must invest in the development of domestic pharmaceutical production capabilities, reducing its dependence on global supply chains and enhancing local drug manufacturing. This would not only make ART more accessible but also position South Africa as a leader in health innovation within the Global South. Moreover, alternative funding models should be explored, such as collaboration with emerging economies through platforms like BRICS, ensuring that funding for HIV/AIDS treatment and prevention is more sustainable and less susceptible to the shifting tides of Western political agendas.
Equally important is the integration of Traditional Health Practitioners (THPs) into the HIV/AIDS care continuum. Traditional healers, with their deep understanding of local cultural and health practices, could play a crucial role in providing complementary treatments, especially in rural and underserved areas. The South African government should adopt a more inclusive health policy that acknowledges the valuable role THPs play, ensuring that they are properly regulated and trained in safe and effective methods of care. This integration would not only address the cultural preferences of many South Africans but also help bridge the gap between Western biomedicine and Indigenous knowledge systems, making HIV/AIDS care more accessible, holistic, and effective.
