The Trump administration has moved to phase out HIV funding for South Africa, a decision that threatens to upend health programs serving the country with the highest number of people living with HIV anywhere in the world. The move is framed as a consequence of South Africa’s failure to respond to policy concerns raised by the White House, and it marks a significant escalation in an already strained diplomatic relationship between the two countries.
PEPFAR funding for South Africa enters a phased withdrawal
The United States has begun initiating a drawdown of programming under the President’s Emergency Plan for AIDS Relief, known as PEPFAR, in South Africa. The decision is tied to a February 2025 executive order in which President Trump accused South Africa of discriminating against its white Afrikaner minority and directed federal agencies to halt aid to the country unless it adjusted its domestic policies. South Africa has consistently rejected those accusations.
The financial shift has been dramatic. South Africa received roughly $456 million in HIV and AIDS funding from the United States in 2024. That figure dropped to approximately $213 million in 2025, and so far in the current year, only $25 million has been allocated. The administration had previously extended a bridging arrangement of $115 million to sustain treatment and prevention programs through the end of March, but that window has now closed.
A country carrying the world’s heaviest HIV burden
South Africa is home to an estimated 7.8 million people living with HIV, the largest such population of any country globally according to World Health Organization data. Until early 2025, American funding accounted for roughly 18 percent of South Africa’s total budget for fighting the virus. The loss of that support at this scale introduces serious uncertainty for treatment programs, prevention efforts, and the healthcare infrastructure built around them over the past two decades.
The administration has also excluded South Africa from a broader initiative to distribute two million doses of lenacapavir, a newer HIV prevention drug that requires only two injections annually and is considered significantly less burdensome than older preventive treatments. Officials argued that South Africa, as a middle-income country, is capable of financing its own pharmaceutical procurement. South Africa began its own rollout of the drug this month.
The Afrikaner dispute driving the policy shift
The administration’s grievances with South Africa extend beyond health policy. The broader tension centers on the South African government’s affirmative action and land redistribution policies, which some Afrikaners argue amount to discrimination against the white minority that governed the country under apartheid for nearly half a century. That system of institutionalized racial discrimination against Black South Africans ended in the early 1990s following sustained domestic resistance and international pressure.
The Trump administration has not only reduced aid but has also granted refugee status to Afrikaners seeking to relocate to the United States, a move that drew international attention earlier this year. South Africa’s government has disputed the characterization of its policies as discriminatory and has not publicly signaled any intention to alter them in response to American pressure.
What comes next for South Africa’s HIV response
Administration officials have framed the PEPFAR withdrawal not as an abrupt termination but as a gradual transition, suggesting the program was never designed to be a permanent fixture of any country’s health system. No timeline for completing the phased drawdown has been made public. For South Africa, the challenge now is determining how to absorb a funding gap of this magnitude while maintaining continuity of care for millions of people who depend on these programs for survival.