The United States government has announced that it will phase out funding for HIV and Aids programmes in South Africa, a move that could significantly affect one of the world’s largest HIV treatment and prevention efforts.
South Africa, which has more than eight million people living with HIV—the highest number globally—has long relied in part on US support through the President’s Emergency Plan for Aids Relief (PEPFAR).
Until 2025, Washington provided an estimated $400 million annually to South Africa’s HIV response, funding that accounted for roughly one-fifth of the country’s HIV programme spending.
However, a US State Department official confirmed that a “phased drawdown” of PEPFAR funding will now begin.
The official said the decision was linked to what Washington described as South Africa’s failure to meet policy expectations set by the US administration. The statement also suggested that South Africa, as a middle-income country, should take greater responsibility for financing its own health programmes.
The move follows a period of strained relations between the two countries since the return of President Donald Trump to office. Tensions have been fueled by disagreements over South Africa’s domestic policies, its foreign relations stance, and allegations from Washington concerning treatment of the white Afrikaner minority—claims strongly rejected by Pretoria.
The US government has previously accused South Africa of policies it says undermine equal opportunity, while also criticising its position in international legal disputes and diplomatic relations.
The South African government has dismissed these claims, maintaining that its policies are aimed at addressing historical inequalities rooted in apartheid and that there is no evidence of the alleged persecution of white citizens.
In response to the funding decision, South Africa’s health ministry said it had not yet been formally notified but emphasized that it has been working toward greater self-reliance in healthcare financing.
Officials also noted that while PEPFAR has played a significant role in supporting HIV programmes, the country’s provision of antiretroviral treatment is largely funded domestically.
The announcement has raised concerns among public health experts, given South Africa’s status as the country with the largest HIV burden in the world. However, US officials maintain that the goal of the policy shift is to encourage sustainability and reduce long-term dependence on foreign aid.
Diplomatic relations between Washington and Pretoria have continued to deteriorate, with recent disagreements including high-level diplomatic tensions and policy clashes on global issues.
The phased withdrawal marks a significant change in US foreign health assistance strategy in one of its most high-profile global health partnerships.
