The United States government has announced plans to end funding for HIV and Aids programmes in South Africa, marking a significant shift in health assistance as diplomatic tensions between the two countries continue to deepen.
South Africa has the world’s largest HIV-positive population, with more than eight million people living with the virus. Until 2025, the US supported the country’s HIV response through the President’s Emergency Plan for AIDS Relief (Pepfar), contributing an estimated $400 million annually.
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A US State Department official confirmed that a “phased drawdown” of Pepfar funding would begin, linking the decision to what the administration described as “South Africa’s failure to make demonstrable progress on policy requests by the administration”.
The official said the move was intended to “foster self-reliance” and reduce dependence on US funding, adding that “South Africa is a middle-income country and is more than capable of supporting its own health programs”.
The decision appears to be tied to broader political disagreements between Washington and Pretoria that have intensified since President Donald Trump returned to office.
Shortly after his inauguration, Trump signed an executive order alleging that “countless” South African policies undermined equal opportunities and fuelled violence “against racially disfavored landowners”.
The South African government has consistently rejected those claims, arguing that its Black Economic Empowerment policies are necessary to address deep-rooted inequalities created during apartheid.
The executive order also cited South Africa’s genocide case against Israel at the International Court of Justice and its diplomatic ties with Iran as factors influencing Washington’s stance.
The White House said that because of these “unjust and immoral practices”, additional aid to South Africa would not be provided.
Trump has also repeatedly claimed that a “white genocide” is taking place in South Africa, allegations that have been widely discredited. The claims nevertheless prompted the administration to establish a refugee programme for Afrikaners, descendants of European settlers who arrived in southern Africa during the 17th century.
Pepfar funding, which accounted for roughly one-fifth of South Africa’s HIV programme spending, had previously been granted a temporary extension through a “bridge plan” introduced last October.
Responding to reports of the funding withdrawal, South Africa’s health ministry said it had not received formal notification from the US government but stressed that it had “long been working on a self-reliance plan”.
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The ministry also sought to reassure patients, noting that while Pepfar played an important role in supporting HIV programmes, the country’s supply of life-saving antiretroviral medicines was funded separately and largely financed by the South African government.
Efforts to repair relations between the two countries have struggled in recent years. Among them was a highly publicised White House meeting between President Donald Trump and South African President Cyril Ramaphosa, during which Trump confronted his counterpart with allegations of discrimination against white South Africans.
Relations were further strained when the United States boycotted the G20 summit hosted by South Africa last November.
The withdrawal of Pepfar funding is expected to place additional pressure on South Africa’s public health system, even as authorities insist they are prepared to sustain critical HIV treatment and prevention services without American support.