South African lives are at stake with the United States planning to phase out its HIV funding for Africa, say experts, but government says the news is not completely unexpected and that it has been working towards increased self-reliance. However, the decision, which comes as the State Department plans to overhaul the Centres for Disease Control and Prevention’s work on a landmark global HIV programme, has been slammed as unfair, purely political, and likely to cost innocent lives, notes MedicalBrief.
Local and international experts have raised concern, and appealed to the US to reconsider the moves which threaten to reverse HIV prevention goals worldwide. The head of the UN’s HIV agency has warned that the decision was likely to cost South African lives, reports BBC News.
“Please do not take money away because you are taking lives away,” UNAids chief Winnie Byanyima said before a UN meeting on the virus, asking Washington to consider a “planned transition”.
She said the cuts risk reversing all of the progress they have made in their HIV response so far.
There are more than 8m people with HIV in South Africa – more than anywhere else in the world, and she urged member states to protect the rights of people with HIV.
“Taking this funding away is taking lifesaving support from the most vulnerable people – I appeal to the United States to reconsider its position.”
On Sunday, the FW de Klerk Foundation wrote a letter to US President Donald Trump, saying cutting the funding would leave millions of sick and vulnerable people paying the price for a political fight that has nothing to do with them.
The letter, addressed directly to Trump, was copied to the State Department and US ambassador to SA Leo Brent Bozell III.
“The withdrawal of Pepfar infrastructure does not penalise a political party,” the foundation’s executive director, Christo van der Rheede, wrote.
“It disrupts lifesaving healthcare linkages for millions of innocent people caught in a geopolitical crossfire.
“Weaponising vital public health infrastructure to enforce ideological compliance provides a dangerous propaganda victory to those who wish to fracture our nation along racial lines,” the letter added.
The foundation called on the US to separate health funding from diplomatic disputes and to pursue what it described as “constructive, bilateral pressure” rather than punitive measures.
It is not clear whether the White House has received or responded to the letter, which came days after the US State Department confirmed it had initiated a phased withdrawal of (President’s Emergency Plan for Aids Relief) Pepfar funding.
But the Department of Health has sought to dispel fears of a public health crisis, with spokesman Foster Mohale saying there was no need for the public to panic – that a transition plan “has long been developed, and the implementation has been ongoing”.
“There is no doubt that Pepfar was a big contributor to our HIV programme, but not to the provision of lifesaving antiretrovirals because we procure 90% of ARVs from the government fiscus, supported by 10% from the Global Fund,” Mohale said.
The Trump administration’s apparent justification to phase out the aid was that the country had failed to address the President’s concerns about alleged treatment of its white citizens, and after its “failure to make demonstrable progress on policy requests by the administration”, a State Department official told POLITICO.
The State Department official said the decision to phase out the funding was in line with President Donald Trump’s February 2025 executive order, accusing the country of discriminating against its white Afrikaner minority and directing US agencies to stop providing aid to the country unless it changes its policies.
Also contributing were South Africa’s relationship with Iran, its Black Economic Empowerment policies, and concerns over the “Kill the Boer” chant – all apparently being unmet conditions behind the decision.
South Africa has been a top beneficiary of Pepfar, receiving some $456m in HIV/Aids funding in 2024.
That dropped to $213m in 2025, according to partial US Government data for that fiscal year. Trump abruptly cut billions of dollars in foreign aid after taking office last year.
So far this year, South Africa has been allocated $25m to fight HIV.
“The United States communicated to the South African Government multiple times at many levels that Pepfar funding would be terminated if they failed to address President Trump’s concerns,” the State Department official noted, adding that South Africa should not need to rely on American aid.
“South Africa is a middle-income country and is more than capable of supporting its own health programmes. Pepfar was never intended to be permanent; its success is measured by countries’ ability to sustain and build upon these gains,” he added.
The US has already excluded South Africa from a plan to supply 2m doses of lenacapavir, saying the country could afford to pay for its own drugs. SA started rolling out the drug this month.
The Trump administration had given South Africa $115m last year in a so-called Pepfar bridging plan to continue funding HIV treatment and prevention until the end of March.
The phased withdrawal is expected to be completed by early 2027, reports BusinessTech, and while it is expected that Bozell will formally inform authorities of the decision, Mohale said no official correspondence had been received.
The Trump administration is accelerating a plan to slash its support for programmes that detect outbreaks like the Ebola one currently overwhelming the DRC, reports The New York Times.
The proposal by the State Department aims to overhaul the CDC’s work on Pepfar that also helps countries manage surveillance for emerging diseases, strengthen laboratory networks and support childhood immunisations.
If the plan takes effect as scheduled on 1 October, it would effectively shut the agency out of overseeing many global health programmes and shift control over the bulk of funds and decisions to the State Department.
The changes may sideline the country’s premier experts on global health and could lead to the closure of about a third of its 60 country offices within the next three years, say some officials.
“This is the end of autonomy and independence and long-term capacity at the CDC for work in global health,” said Dr Atul Gawande, a former head of global health at the US Agency for International Development and a Professor at Harvard Medical School.
The proposal is intended to diminish the agency’s authority in Pepfar, which is credited with saving 26m lives since formation by President George W Bush in 2003. Before 2025, USAID managed more than half of Pepfar’s budget, and the CDC handled much of the rest.
The changes may jeopardise the health of the more than 12m people on HIV treatment supported by CDC funds, said Dr Michele Montandon, who led the agency’s team on mother-to-child transmission of HIV until she was laid off in August.
“This will completely destabilise HIV work abroad,” she added. “We’ve seen service disruptions, deaths and babies born with HIV after shuttering USAID, and we can expect more to come if the CDC is also shut out of this work.”
The State Department said the plan would have no adverse effect on the CDC or the work it does abroad.
“The State Department and Health and Human Services are working together to preserve the CDC’s critical capabilities while modernising how foreign assistance is delivered,” said Tommy Pigott, a State Department spokesman. (The CDC is a division of the Department of Health and Human Services.)
“The facts are straightforward: the State Department expects CDC overseas funding to increase, not decrease, under the America First Global Health Strategy, and no CDC offices are being closed because of State Department decisions,” he said.
Andrew Nixon, a spokesman for the Health and Human Services Department, said: “What is under way is a modernisation of a fragmented system that for years tolerated duplication, overlapping investments and poor co-ordination across agencies.”
In a typical year under the current system, the State Department would hand the CDC a budget of about $2bn. The agency then would work with countries to set their health priorities and allocate the funds to ministries and partner organisations to support them.
The new plan replaces the health agency’s budget for the work with a “fee-for-service” menu that requires countries to choose and pay for assistance from CDC staff in specific areas – wastewater and environmental surveillance, for example.
“Global health response should be based on need and the threat level, not whether a government signed up for a tiered service package in advance,” Montandon said.
“It’s contrary to the US interest to not maintain a large, substantial CDC programme in these countries,” said John Blandford, who worked at the State Department and led the CDC division that includes the programme from 2013 to 2016. Blandford then oversaw CDC country offices, first in Vietnam and then in South Africa, till he retired from the agency last year.
He added that the State Department “does not have the expertise or the capacity to actually know what it should be doing in these programmes”.
Over the decades, the agency’s work through Pepfar extended well beyond HIV to support the people and infrastructure required for other public health activities, often with little additional overhead. Together, the funds helped to maintain about 1 500 overseas employees, 1 700 labs and a programme that trains local disease detectives for outbreak response.
For example, Pepfar helped build up skills in diagnostics, contact tracing and data analysis that helped countries combat Covid. More recently, South African researchers were able to quickly decode the genetic sequence of the hantavirus that caused an outbreak. The CDC’s country office in the Congo is actively engaged in the current Ebola response.
The Trump administration’s dismantling of USAID last year has led to sharp decreases in the numbers of people newly tested, diagnosed and treated for HIV, and of people taking preventive drugs. The number of children who began treatment has fallen by 15%, according to a report this month from the Clinton Health Access Initiative.
This year, the administration delayed the transfer of Pepfar funds to the CDC by months, holding back money already appropriated by Congress for the work and eventually disbursing only $1.3bn. Now, the new plan will “basically destroy Pepfar”, said Dr Thomas Frieden, who led the CDC under President Barack Obama.
The administration is moving away from disease-specific programmes like Pepfar entirely, instead structuring foreign aid as bilateral agreements with governments, often with strings attached.
The new agreements do not set goals of eradicating polio, or reducing the HIV and TB pandemics or maintaining goals in child mortality, Gawande said. “Instead, they’re just individual transactional deals with no larger goal or purpose in mind.”
IOL article – FW de Klerk Foundation takes on Trump over SA’s HIV funding cuts (Open access)
EWN article – US stands firm on halting South Africa's HIV/AIDS funding (Open access)
Politico article – Trump administration to phase out HIV funding for South Africa
The New York Times – New Plan Scales Back C.D.C.’s Work on Diseases Abroad
See more from MedicalBrief archives:
Africa’s HIV response must pivot from aid dependency to ownership
SA HIV programme future unclear as Pepfar dodges $400m cut
Drop in US funding may cause HIV/Aids epidemic to ‘go out of control’