The decision by Washington to slash HIV funding in South Africa has sent shockwaves through the global health community, endangering programmes that British taxpayers have helped sustain. The cut, amounting to hundreds of millions of dollars, threatens to unravel years of progress in combating the epidemic in a country where 7.8 million people live with HIV.
The funding freeze hits the President’s Emergency Plan for AIDS Relief, known as PEPFAR, a programme that has provided antiretroviral drugs to over 1.5 million South Africans. Without these drugs, patients face a stark choice: ration their medication or risk developing drug-resistant strains of the virus. Health workers on the ground are already reporting clinics turning people away.
For British-funded initiatives like the Global Fund to Fight AIDS, Tuberculosis and Malaria, the American withdrawal creates a dangerous gap. The UK has pledged £1.4 billion to the Global Fund for 2023-2025, but that money was never meant to fill an American void. Instead, it was designed to complement US efforts. Now, Whitehall officials are scrambling to reassess their commitments as the scale of the damage becomes clear.
Jane Mkhize, a nurse at a clinic in Soweto, described the scene as “devastating”. She said: “We have patients who have been stable for years. They come in panicked because they know their next prescription won’t be filled. Some are already talking about stopping treatment. That’s a death sentence.”
The cuts also threaten the livelihoods of thousands of community health workers, many of whom are women from the townships. These workers earn modest stipends but provide essential care and support. Without US funding, their positions are at risk. “For these women, this is not just about health,” said Thandi Ndlovu, a union organiser. “It’s about their families, their homes. The ripple effects will be huge.”
The UK has long positioned itself as a leader in global health, with a particular focus on HIV/AIDS in sub-Saharan Africa. But the American withdrawal tests that leadership. The British government has not yet announced a supplementary funding package, and aid experts warn that public opinion at home may not support increased spending on foreign health when the NHS is under pressure.
Labour’s shadow international development secretary, Lisa Nandy, called on the government to “urgently convene an emergency meeting with international partners to plug the hole left by the US”. She added: “This is not just a moral failure. It is a strategic one. A resurgence of HIV in South Africa will have global consequences, including for the UK.”
The timing could not be worse. South Africa is already grappling with high unemployment and a crumbling public health system. The HIV programme was a rare success story. Now, the gains of the last two decades are under threat.
The US decision also raises questions about the future of other British-backed initiatives that rely on American partnership. The Global Fund is heavily dependent on US contributions, which made up 32% of its budget in 2022. Any further cuts would hit programmes in Uganda, Nigeria and beyond.
For now, the focus is on damage control. The UK’s Foreign, Commonwealth and Development Office said it is “in close contact with the South African government and international partners to assess the situation”. But without a clear plan, the most vulnerable will pay the price.
As one clinic worker put it: “The medicine doesn’t come from promises. It comes from funding. And right now, the shelves are going empty.”
