South African civil society organizations have voiced concerns that adolescent girls and women are among the most vulnerable groups to be affected by the U.S. administration's decision to phase out its annual funding for the country's HIV programs. The President's Emergency Plan for AIDS Relief (PEPFAR), which has supported South Africa's response to HIV and AIDS for 20 years, is slated for a phased drawdown, with most programs expected to conclude by the end of September.
PEPFAR, credited with saving over 20 million lives globally, has been a significant financial contributor to South Africa's efforts against the epidemic. The country has the highest number of people living with HIV, with approximately 8 million individuals, or about 12.7% of its population, relying on these programs. The U.S. State Department indicated that critical personnel support would continue through March 2025.
The decision to halt funding follows broader foreign aid cuts announced by U.S. President Donald Trump in January 2025, which were attributed to political issues including South Africa's Black Economic Empowerment policies, disputed allegations of genocide against the white minority Afrikaner community, and land expropriation laws. The U.S. also cited South Africa's stance against Israel at the International Court of Justice.
A U.S. State Department spokesperson stated that the South African government was informed that PEPFAR funding would be withdrawn if specific issues, such as the unequivocal condemnation of race-based incitement to violence, were not addressed. The anti-apartheid song "Kill the Boer," which some interpret as inciting violence against Afrikaners, was specifically mentioned.
According to the South African government, PEPFAR funding constituted approximately 17% of its budget for HIV programs, excluding the purchase of antiretroviral drugs, which are largely self-funded by the country. However, other HIV-related programs in 27 districts have already experienced adverse effects, leading to the shutdown of some support facilities and the layoff of front-line workers and volunteers.
The South African health department has been working on a self-reliance plan to mitigate the impact of funding withdrawals since an initial freeze on foreign assistance and cancellation of USAID grants in January 2025. The country announced a $45 million emergency fund last year to address some of the anticipated gaps.
Civil society group Section27, which has evaluated the impact of funding withdrawals in three high-HIV prevalence districts, reported that prevention services have been particularly hard-hit. "As the health system started to feel the pressure, the response was to prioritize treatment continuity versus prevention," said Tendai Mafuma, a senior legal researcher at Section27.
The Anova Health Institute reported discontinuing its PEPFAR-funded programs and laying off approximately 3,000 health workers since last year. Dr. Kate Rees, a public health medicine specialist at Anova, noted that community delivery of pre-exposure prophylaxis (PrEP) and other prevention services has been significantly impacted. She added that priority populations, including children, adolescents, young people, men who have sex with men, and people who use drugs, are among the most affected.