The United States has terminated financial support for HIV treatment and prevention programmes in South Africa, a decision that threatens to undo decades of progress in the global fight against the epidemic. The move, confirmed by the State Department on Wednesday, halts disbursements to the President’s Emergency Plan for AIDS Relief (PEPFAR) for projects in the country, which receives the largest share of the programme’s funding.
South Africa is home to 7.8 million people living with HIV, the highest number of any nation. PEPFAR, launched in 2003, has provided antiretroviral therapy to more than 5 million South Africans and supported prevention efforts that reduced new infections by 40% since 2010. The abrupt cessation of funds will disrupt the supply of medication for 1.5 million patients, according to the South African Department of Health.
The decision comes amid a broader review of US foreign aid under the current administration, which has prioritised domestic spending and questioned the efficacy of multilateral health initiatives. Officials cited “reassessment of strategic priorities” but offered no timeline for restoring the funding. The move has drawn sharp criticism from global health experts, who warn of a resurgence of HIV-related deaths and new infections.
Dr. Nkosi Mzizi, a public health specialist at the University of Cape Town, described the cut as “catastrophic”. “We have built a fragile but effective infrastructure. Without US support, that infrastructure will collapse within months,” she said. The South African government has pledged to bridge the gap using domestic resources, but faces budget constraints exacerbated by the pandemic and economic stagnation.
The United Nations Programme on HIV/AIDS (UNAIDS) called on Washington to reverse the decision, noting that global HIV funding has plateaued in recent years. “This is a blow to the 2030 goal of ending AIDS as a public health threat,” said UNAIDS Executive Director Winnie Byanyima.
The UK’s Department for International Development, which coordinates with PEPFAR in several African nations, expressed “deep concern” and urged the US to uphold its commitments. Meanwhile, analysts suggest the move may weaken American soft power in sub-Saharan Africa, where health diplomacy has long been a pillar of US foreign policy.
For now, patients in South Africa face an uncertain future. Clinics in rural KwaZulu-Natal and Gauteng have already reported shortages of test kits and antiretroviral drugs. The full impact will become clear in the coming weeks as stocks dwindle.