US to end funding of South Africa's HIV programmes

The United States government has announced plans to begin a phased withdrawal of funding for HIV and Aids programmes in South Africa, linking the decision to what it describes as a lack of progress by Pretoria on policy concerns raised by the administration.

The move marks a significant development in increasingly strained relations between the United States and South Africa under the administration of President Donald Trump.

South Africa carries the world's largest HIV burden, with more than eight million people living with the virus. For more than two decades, the United States has been a major contributor to the country's HIV response through the President's Emergency Plan for AIDS Relief (PEPFAR).

Prior to 2025, PEPFAR was providing approximately US$400 million annually to support HIV prevention, treatment and community health programmes in South Africa, accounting for roughly one-fifth of total HIV programme spending.

A United States State Department official confirmed that a "phased drawdown" of PEPFAR funding would now begin.

According to the official, the decision was linked to "South Africa's failure to make demonstrable progress on policy requests by the administration."

The official added that Washington's objective was to encourage greater self-sufficiency.

"The intention of the US government was to foster self-reliance and reduce dependency on American funding," the official said, arguing that South Africa, as a middle-income country, possesses the capacity to finance its own health programmes.

The announcement follows months of deteriorating diplomatic relations between Washington and Pretoria.

Shortly after taking office, Trump issued an executive order criticising several South African government policies, including measures aimed at addressing historical economic inequalities.

The White House has argued that certain policies discriminate against the country's white minority, particularly Afrikaners, and has cited those concerns as part of its justification for reducing assistance.

The South African government has strongly rejected those allegations, maintaining that its transformation and Black Economic Empowerment policies are designed to address the legacy of apartheid-era exclusion and inequality.

South Africa has also disputed claims by Trump and some members of his administration that white South Africans are being systematically targeted.

In response to reports of the funding withdrawal, South Africa's health ministry said it had not yet received formal notification from the United States government but emphasised that contingency planning had already been underway.

The ministry said it had "long been working on a self-reliance plan" to reduce dependence on foreign donor funding.

Officials also stressed that the country's antiretroviral treatment programme remains largely protected because the procurement of life-saving HIV medication is financed primarily through domestic resources rather than donor funding.

According to the ministry, most antiretroviral drugs are funded directly by the South African government, limiting the immediate risk of treatment interruptions for millions of patients.

However, public health experts have warned that reductions in PEPFAR funding could still have significant consequences for prevention programmes, community outreach initiatives, HIV testing services and support programmes run by non-governmental organisations.

The planned withdrawal of funding is expected to place additional pressure on South Africa's healthcare system as authorities seek to sustain one of the world's largest HIV treatment programmes while absorbing responsibilities previously supported by international donors.

The development also highlights the growing intersection between international aid, diplomacy and domestic policy disputes, with health funding increasingly becoming entangled in broader political tensions between the two countries.