US to phase out US$400m HIV funding for South Africa as diplomatic tensions deepen

The United States has announced plans to phase out HIV/AIDS funding for South Africa, a move that could withdraw roughly $400 million annually from one of the world’s most heavily affected countries, where more than 8 million people are living with HIV.

The decision affects support provided through the President’s Emergency Plan for AIDS Relief (PEPFAR), a flagship US global health programme that has been central to HIV prevention and treatment efforts across Africa since its launch in 2003. The planned withdrawal represents one of the most significant shifts in US health assistance policy in recent years.

According to US State Department officials, the funding will be gradually reduced as part of a broader strategy to encourage “self reliance” among middle income countries. Washington argues that South Africa, as a relatively advanced African economy, should assume greater responsibility for financing its own healthcare systems.

However, the move comes against a backdrop of worsening diplomatic relations between Washington and Pretoria. Tensions between the two countries have escalated since the Trump administration returned to office, with disputes spanning foreign policy, trade relations and domestic governance issues.

The White House has previously accused South Africa of pursuing policies it claims disadvantage certain groups and has criticised Pretoria’s foreign policy positions, including its case against Israel at the International Court of Justice. South African officials have strongly rejected these claims, maintaining that their domestic policies are aimed at addressing historic inequality.

The HIV funding cut now extends that political friction into the public health sector, raising concerns among experts about the potential impact on one of the world’s largest HIV treatment programmes.

South Africa carries the highest HIV burden globally, with UNAIDS estimating that more than 8 million people in the country are living with the virus. Over the past two decades, PEPFAR has played a major role in supporting the country’s response, funding testing services, prevention campaigns, treatment monitoring, and community outreach programmes.

At its peak, the programme contributed around $400 million annually to South Africa’s HIV response, supporting thousands of healthcare workers and civil society organisations. These resources have helped expand access to antiretroviral therapy and significantly reduce HIV-related deaths.

While South African health authorities have not yet received formal notification of the full details of the funding withdrawal, officials say they have been anticipating a gradual decline in donor support and have increased domestic funding for antiretroviral drug procurement.

Health experts, however, warn that while treatment provision may remain stable in the short term, prevention programmes and community-based services could be severely affected. These include outreach initiatives that target high-risk populations, HIV testing drives, and support systems that help patients remain on treatment.

Public health analysts also caution that disruptions to PEPFAR-funded infrastructure could weaken data collection systems and reduce the effectiveness of monitoring and evaluation frameworks that are essential for controlling the epidemic.

The US State Department has said the withdrawal will be phased, allowing time for adjustment and transition. Officials argue that South Africa’s relatively strong tax base and healthcare infrastructure make it capable of sustaining HIV programmes without long-term foreign assistance.

Critics of the decision, however, argue that HIV is not only a health issue but also a development challenge that requires sustained international cooperation. They warn that abrupt funding reductions could reverse progress made over decades in reducing infection rates and expanding treatment coverage.

The move also signals a broader shift in US foreign aid policy under the current administration, which has increasingly prioritised reductions in overseas assistance and greater emphasis on domestic responsibility among recipient countries.

For South Africa, the decision adds another layer of strain to its already complex relationship with Washington. For millions of people living with HIV, it raises uncertainty about the future of services that have been central to their survival.

As the phased withdrawal begins, attention will turn to how effectively South Africa can absorb the financial gap, and whether alternative funding sources—domestic or international—can sustain one of the largest HIV responses in the world.