The Trump administration has announced an immediate halt to all HIV aid funding in South Africa, a move that humanitarian groups warn will unravel decades of progress and leave millions without life-saving treatment. The decision, confirmed by the US Agency for International Development (USAID) on Monday, pulls the plug on programmes that have supported antiretroviral therapy for over 4 million South Africans.
The funding freeze is part of a broader review of foreign aid under the President’s Emergency Plan for AIDS Relief (PEPFAR), which has been the cornerstone of the global HIV response since 2003. South Africa, the country hardest hit by the epidemic, receives roughly $400 million annually from the US to combat HIV. That money pays for drugs, clinic staff, testing kits and community outreach workers who trace patients who miss appointments.
“This is a death sentence for many,” said Dr Thandi Ndlovu, a physician at a public clinic in Soweto. “We have people who are stable on treatment. Without their pills, the virus will rebound. They will get sick and die. It is that simple.”
The timing could not be worse. South Africa is still recovering from the Covid-19 pandemic, which strained its health system and disrupted HIV services. According to UNAIDS, the country accounts for nearly 20% of all new HIV infections globally. Just last year, it announced a target to end AIDS as a public health threat by 2030.
Community organisations that rely on US grants are now scrambling to find alternative funding. Many have already been told to stop spending. “We have to tell our patients we can no longer provide food parcels or transport vouchers,” said Busisiwe Magwaza, a treatment advocate in Durban. “For people who are hungry, that is devastating. It is a direct blow to the real economy of survival.”
The cuts will also hit the supply chain for generic antiretroviral drugs. South Africa produces its own ARVs, but US funding covers a significant portion of the raw materials and testing. Without it, the country may face drug shortages within months.
Human Rights Watch called the move “cruel and reckless”, noting that PEPFAR has saved more than 20 million lives worldwide. The South African government has yet to comment officially, but local health officials are in crisis talks with the US embassy.
For the millions of South Africans living with HIV, this is not a diplomatic squabble. It is a matter of life and death. The question now is how many will fall through the cracks before the global community steps in.