Cape Town has recorded encouraging improvements in both Anti-Retroviral Treatment (ART) uptake and access to Pre-Exposure Prophylaxis (PrEP), even as the health system faced significant pressure in 2025. The USAID Stop Work Order earlier in the year led to reduced partner support and fewer counsellors, nurses and clerks in City Health facilities, creating major gaps in frontline service delivery. Yet, despite these setbacks, local teams continued to push forward with innovation, resilience and community-centred strategies.
Much of the City’s recent work aligned with the National Close the Gap Campaign, which concludes on World AIDS Day. This national effort focused on strengthening HIV and TB services while reconnecting more than seventy thousand people living with HIV in the Cape Town Metro who are currently not in ART care. To support this, City Health identified eighteen high-burden facilities and intensified work on improving access, strengthening internal systems and providing additional support to clients living with HIV.
Counsellors have historically played a critical role in HIV testing and patient education. To fill the gap left by the loss of NPO support staff, the City convened a series of HIV testing and counselling workshops for clinicians, equipping them with new skills to maintain continuity of care. The workshops reinforced the importance of patient-centred counselling, helping clients identify barriers to care and supporting them in problem-solving. This approach also helped normalise treatment interruptions and encouraged people to reconnect with services without fear or stigma.
One of the key public health messages emphasised during these sessions was U equals U – Undetectable equals Untransmittable – which is the scientific reassurance that people living with HIV who maintain an undetectable viral load cannot transmit the virus to their sexual partners. In November, the City hosted a webinar featuring a representative from the South African National AIDS Council to deepen staff understanding of the science behind this message.
Another area of focus has been the expansion of Six-Month Multi-Month Dispensing through ART Clubs at selected facilities. This model allows stable patients to collect a six-month supply of medication in a single visit, reducing clinic congestion and supporting better adherence. Currently, more than ninety thousand people receive ART at City Health facilities, with nearly fifty thousand doing so through the ART Club system. By June 2026, the City anticipates that more than half of all ART patients will be accessing services at sites offering six-month dispensing.
At the same time, the City continues to increase access to HIV self-screening kits, with a focus on pregnant women and their partners. This approach is helping to reduce barriers to testing and expand early detection.
Preventing new HIV infections remains a central priority. Oral PrEP continues to be offered throughout the metro, and the introduction of the six-monthly injectable PrEP option, Lenacapavir, at selected facilities next year is expected to expand prevention choices even further. Between June 2024 and June 2025, the number of clients remaining on PrEP grew significantly from 37 357 to 51 277.
As World AIDS Day approaches, the City highlights the dedication of health workers who have helped sustain and strengthen services during an extremely challenging period. Their commitment has played a vital role in ensuring that people living with HIV continue to receive the care, support and dignity they deserve.
