BHEKISISA: Why climate change belongs in HIV reporting and how to cover the connection

On 12 April 2022, Mfundo Shezi woke when the skies cracked open and unleashed a merciless deluge over KwaZulu-Natal. The 32-year-old, who usually sleeps in a park in Umbilo in Durban, immediately fled for shelter, abandoning all he owned.

Shezi didn’t have much, but by the time he returned the next morning, he found that the flood had taken all of his possessions. That included his ID and his monthly supply of antiretroviral (ARV) treatment for HIV, which he had been taking faithfully since he started treatment in 2021. 

“On that day, I missed a dose for the first time,” he told Bhekisisa. Without taking his HIV medications consistently, he knew he’d get sick.

He panicked. He tried to get to the local clinic but wasn’t able to get there. So Shezi walked to the government hospital. It was open, but without his ID book – or a transfer letter from his regular clinic, which would allow him to get his medication – they couldn’t help. 

Experts say a changing climate will probably bring on more bouts of severe weather like this flood, which killed more than 450 people. But the flood itself would not somehow make Shezi’s HIV more infectious or deadly. What changed was everything affected by it: the destroyed roads, the paper file that held his treatment history, the proof he was who he said he was.

Between 2010 and 2023, new HIV infections fell by almost 60% in Africa, meaning that for every 10 people who were getting HIV in 2010, four got it in 2023. But the region could start losing those gains as climate shocks collide with shrinking HIV funding.

Climate scientist Christopher Jack, deputy director of the Climate System Analysis Group at the University of Cape Town, and public health specialist Coceka Nogoduka, who, for 18 years, has helped to shape how South Africa deals with HIV and tuberculosis, spoke to a group of journalists in a Bhekisisa webinar on the links between climate change and HIV, what it means and what can be done to get ahead of it. Here’s what we learned.

Seven key connections

1. Climate change does not make HIV more infectious

Extreme heat, rain or drier conditions don’t make the virus more infectious or make people with HIV sicker. But it can change people’s behaviour and how, when and where they can get healthcare and medication.

2. A warmer world could mean far more HIV

If the world keeps pumping greenhouse gases such as carbon dioxide and methane into the air at the rate it is now, the average global temperature could, in a worst-case scenario, be 5°C higher than it was about 150 years ago. 

If the air becomes that much warmer, 25-37% more people in sub-Saharan Africa might have HIV by 2050 than would have been expected without such harsh global warming, a modelling study shows.

Meanwhile, every time a bad drought hits – when there is less than 20% of the normally expected rainfall – HIV infections could climb by 11% in rural areas in Africa, where many people already have HIV. Heavy rainfall and flooding can increase the chances of getting HIV by 14%, and make it 11% more likely for someone to get another sexually transmitted infection.

In the rest of our story, we explain why. 

3. When disaster forces people to move, normal treatment breaks

Even when weather experts know a flood is on the way, people may still have to flee their homes suddenly. When that happens, they might lose their ID or find it impossible to get to their usual clinic, breaking the daily routine they need to stay healthy with HIV. In 2025, natural disasters across sub-Saharan Africa forced people to move nearly 3 million times.

When people are displaced by extreme weather, their homes might be washed away with their identification documents, and they might not even be able to get into a new health facility and be able to identify themselves so that they can then be re-registered into our public health systems. – Coceka Nogoduka

For someone on treatment, that routine is a matter of life and death. If they can’t collect medication regularly, the virus can get a foothold and start multiplying, making people sick and able to infect others. 

4. When people move, their medical records usually don’t

South Africa has long planned a national electronic patient record system that would allow a person’s patient file to follow them if they move and seek care at a different clinic or hospital. But 10 years after it was first proposed, that system is not yet fully in place; only the Western Cape has a fully rolled out system in place. In most clinics, patient records are still kept on paper. Even if someone can get a transfer letter, which is needed to get treatment at a different clinic, they may be counted as someone who has stopped taking their medication in one place and considered a brand-new patient in another – something which could not only affect patient care but also skew how HIV cases are counted in national registers.

5. Surviving a disaster can drive risky behaviour

Women who move because extreme weather has destroyed their livelihood or their access to food are more likely to trade sex for basic necessities such as food or shelter.

When someone has to trade sex just to survive, they often lose their say in the relationship. Because they are relying on that partner for their basic needs, the power imbalance makes it much harder for them to insist on using a condom or to have safer sex. Research shows that when women are forced into these survival strategies, they are twice as likely to get HIV.

6. Repeated shocks wear down the system

Stopping HIV needs both treatment and prevention in place – testing, clinic visits and offering condoms or HIV prevention medication such as the daily anti-HIV pill or six-monthly HIV prevention shot, lenacapavir. HIV prevention meds lower someone’s chances of contracting the virus to close to zero. Weather disasters put health systems under pressure: clinics close because they are flooded or have no power to keep medicines at the right temperature, and flooded roads and broken bridges stop delivery trucks from reaching remote areas. During major floods in Namibia’s Ohangwena region in 2009, damaged roads and floodwaters made 41 health facilities unreachable.

How many more HIV cases could climate change bring? 

When HIV-negative people can’t access their next HIV prevention medication dose in time, they’re no longer protected against the virus and their chances of getting HIV increase. 

While one flood or drought won’t undo decades of HIV progress, South Africa’s high number of people living with HIV, alongside more frequent and intense weather and sharp decreases in HIV funding, means we’ll be even more vulnerable when the next climate shock lands.

Often we have inadequate infrastructure. The roads are not built well, or not well maintained, and bridges aren’t designed for extreme rainfall events. This often compounds with weak health systems; a non-climate driver is now compounded with this climate impact. These cascade through the system, through infrastructure, through access to healthcare, through health outcomes, and then beyond that into livelihoods, loss of primary breadwinners, and the education system. – Christopher Jack

7. What could help

Records that follow a patient would keep treatment going when people move. Health facilities can be built to withstand shocks, and leaders can be held to plans already on the books. 

South Africa’s Climate Change Act came into operation on 17 March 2025, with a national adaptation strategy meant to follow within a year to help guide how the country prepares and responds.

After Cyclone Freddy swept away paper health documents, medicines and supplies in Malawi in 2023, its former health minister, Khumbize Kandodo Chiponda, acknowledged it as a failure of the health system that should be urgently reformed. She set about introducing digitised health records, stronger emergency planning and health facilities that can withstand shocks – an example of how accountability can spur change.

Connections and angles

Climate change and HIV are connected in many ways – and that’s often where the stories are. Here are some ideas on where to look and what to keep in mind.

Before and after: Talk to community members to find out how they were affected, and to healthcare providers, clinic managers and provincial health departments about what happened to patients after recent floods or droughts. Ask:

• Were clinics accessible after severe weather?

• Were drug supplies delayed?

• Did testing or PrEP services pause?

• Did more patients miss their HIV medication pickups?

• Were people able to transfer smoothly from one clinic to another?

Survey systems: Find the gaps in transport, healthcare and medicine supply chains and the movement of people. That can give concrete examples of system failures that need to be addressed.

Follow the records: What happens to a patient’s file when they move? Why is South Africa’s digital health record system still delayed? Would National Health Insurance change things for the better or worse? 

Accountability and action: South Africa’s Climate Change Act came into operation on 17 March 2025, with plans for a national adaptation strategy to be released within a year. How far along is the plan? What is in it? Are hard-hit provinces being prioritised? Does disaster planning include provisions for HIV treatment? For example, while Nogoduka says there are strategies that are being built, she worries there’s too much emphasis on physical infrastructure, such as ensuring clinics have backup water and electricity, and not enough on figuring out how to hand out HIV medication if a clinic is completely washed away.

Solutions and resilience: Which clinics are adapting, and how? Compare South Africa’s disaster planning with more proactive models from other middle-income countries. 

Additional resources

Talk to experts

Christopher Jack is a climate scientist and deputy director of the Climate System Analysis Group at the University of Cape Town. He also co-leads the science team at the Red Cross/Red Crescent Climate Centre, where he provides support on climate risk for humanitarian organisations around the world. Email: cjack@csag.uct.ac.za. His webinar presentation is here.

Coceka Nogoduka is a public health specialist with over 18 years of experience in HIV and TB management. She has worked and consulted for the US government’s HIV funding programme, Pepfar, the South African National Aids Council, UNAids and the health department in South Africa. Email: nogodukaC@unaids.org. Her webinar presentation is here.

Research institutions working on the HIV and climate link

• Africa Health Research Institute

• Climate System Analysis Group, University of Cape Town

• Environment and Health Unit, South African Medical Research Council

Want to read more? 

• The falling down place: After the 2022 floods in KwaZulu-Natal, Inanda began rebuilding. But the damage went far beyond destroyed homes and roads. The story explores how repeated climate disasters leave lasting psychological scars in communities already living with poverty, violence and continuous trauma. As extreme weather becomes more frequent, the question is how to rebuild infrastructure and also how to recognise and support mental health in places where even the language for trauma can be hard to find.

• I missed a dose for the first time: How the KZN floods derailed HIV treatment: Mfundo Shezi lost his ID and HIV medication after the April 2022 floods in KwaZulu-Natal. The story shows how extreme weather disrupts HIV care: clinics close, roads fail and people fall out of treatment, often not returning. It argues South Africa’s HIV and disaster plans don’t align and highlights Namibia’s proactive flood strategy as a more practical model.

• There is no planet B: How HIV can teach us to deal with the climate crisis: This opinion piece argues that the HIV response offers lessons for tackling the climate crisis, from community mobilisation and activism to science-driven policy and global solidarity. It shows how the tools that helped turn HIV from a death sentence into a manageable condition, like data, accountability and tapping into grassroots leadership, can lead to better climate action.

• The triple whammy: HIV, migration and climate change: Climate change, migration and HIV intersect through disrupted livelihoods and strained health systems. As droughts and floods push people to relocate, they are forced to break their treatment routines and may not get the help they need to prevent or treat HIV. The “triple whammy” is not three separate crises but a convergence of three: how movement and climate stress combine to make HIV harder to prevent and manage. DM

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.