A mobile clinic supported by the President's Emergency Plan for AIDS Relief (PEPFAR) in South Africa. The U.S. announced it would cut off funding for HIV projects in the country. Credit: Instagram By Ed Holt
BRATISLAVA, Jul 2 2026 (IPS) A U.S. decision to cut off funding for HIV projects in South Africa has been condemned amid warnings it could be “catastrophic” for efforts to control the disease in the country. At the start of last year, the White House had announced massive cuts to U.S. foreign aid, including to South Africa, significantly impacting some HIV projects in the country. But last month (June 2026), U.S. officials confirmed plans to begin a drawdown of what remaining financial support it was providing through the President’s Emergency Plan for AIDS Relief (PEPFAR), saying the money was no longer needed given South Africa’s wealth but also seemingly linking the move to the government’s failure to meet specific U.S. political demands.
HIV experts and activists have warned the abrupt ending to the funding – all financing is expected to end by early next year and funding for most projects is planned to be cut by the end of September this year, according to the U.S. State Department – could drive increased spread of the disease and many avoidable deaths in a country which already has the world’s highest HIV burden.
“The phased withdrawal of U.S. HIV funding from South Africa is likely to have significant implications for HIV prevention, treatment, and community health systems. The withdrawal of funding threatens a wide range of services, including community outreach programmes, HIV testing services, mobile clinics, data and monitoring systems, PrEP delivery, and targeted interventions for populations at highest risk of HIV acquisition,” Bruce Tushabe, an HIV activist and consultant with the South African Litigation Centre-SALC, told IPS.
For more than two decades, PEPFAR funding has been crucial to South Africa’s response to HIV and tuberculosis, providing around USD 8 billion since 2003 to civil society organisations, community health programmes, clinics, researchers, health worker salaries, and government institutions. Data from PEPFAR itself shows that almost three quarters of people living with HIV in the country are on treatment with some form of support from the organisation.
PEPFAR’s funding is thought to have helped save millions of lives by strengthening and expanding access to prevention, treatment, care, and support services in South Africa.
While over the years HIV treatment has increasingly been covered by state funding – today the state procures 90% of Antiretrovirals (ARVs) using government funds, with the remaining 10% coming from the Global Fund to Fight AIDS, Tuberculosis and Malaria – PEPFAR money has remained essential for financing much prevention.
Activists say that the withdrawal of funding now, without a proper transition plan in place, could be devastating, especially given how hard prevention services have already been hit by the funding cuts announced in early 2025.
According to media reports in South Africa, thousands of jobs, including at frontline healthcare partners, have been lost because of those cuts.
Meanwhile, the Treatment Action Campaign (TAC), a South African HIV NGO, says community-led monitoring has shown that since the 2025 cuts, 82% of facility managers have reported staffing shortages, 15% of public healthcare users surveyed said waiting times were longer than usual, 30% of public healthcare users surveyed reported not being offered HIV testing when attending a health facility, and 28% of people said it took longer to collect ARVs.
“The withdrawal of this funding at this critical juncture, without an adequate transition plan, threatens to reverse hard-won gains in the fight against HIV and TB,” TAC said in a statement.
“These cuts are not abstract budget decisions. They have real consequences for people living with HIV, particularly adolescent girls and young women; sex workers; people who use drugs (PWUDs transgender people; gay, bisexual and other men who have sex with men (GBMSM migrants; and people living in poverty. Reduced access to testing, prevention, treatment adherence support, and community outreach will inevitably lead to increased HIV transmission, treatment interruptions, preventable illness, and avoidable deaths,” the group said.
Some studies have estimated a complete, unmanaged withdrawal of U.S. funding for HIV programmes could lead to as many as 296,000 additional HIV infections and up to 65,000 extra deaths by 2028.
Tushabe said there was particular concern over the impact of the funding withdrawal on key and vulnerable populations who often depend on community-led and network-based services that operate outside conventional healthcare facilities.
“Many of these services provide stigma-free, accessible, and trusted points of care that are not easily replaced within mainstream health systems,” he said.
The South African Department of Health has tried to play down the potential impact of the withdrawal of funding.
In a statement , it said that while the government had not officially been informed by the U.S. about the end of the funding, the move was not a surprise and that the Health Ministry has been working on a “self-reliance plan” to minimise the impact of funding withdrawal since the cuts to U.S. foreign aid last year.
“Thus, there is no need for the public to panic because the transition plan has long been developed, and the implementation has been ongoing,” the Department of Health said.
It added that while PEPFAR had supported the Department of Health in 27 HIV/AIDS ‘high burden’ districts out of 52 districts in the country in eight provinces, public health facilities remain accessible for clients, including those who used to receive health services from PEPFAR funded clinics.
But HIV experts say despite the government’s statements, the HIV response is going to inevitably suffer.
“This is serious,” Linda-Gail Bekker, Director of the Desmond Tutu HIV Centre, told IPS.
“Although the health ministry has publicly stated that we should be fine and it is business as usual, [the funding that is being withdrawn] was a large amount of money that supported some very key components of our HIV/TB response, especially primary prevention. Losing this must have significant impact. It may not directly impact the general treatment program, but I have no doubt it is having an immediate impact on many aspects of the HIV response,” she added.
HIV activists have called on the U.S. to rethink its decision.
Speaking ahead of the high-level UN conference on HIV/AIDS on June 22, Winnie Byanyima, Executive Director of UNAIDS, said, “Taking [the funding] away is taking away life-saving support from the most vulnerable people. So, that is sad. And I would ask the United States to reconsider their position.”
Other groups, such as TAC, called on the White House to “engage with affected governments, communities, and civil society organisations to mitigate the devastating consequences of the funding withdrawal”.
But amid the calls for a rethink on the move, there is also a deep anger among many activists over the reasons given for the decision.
Reports of the funding stop carried in U.S. media cited a U.S. State Department official saying the funding stop had come “following South Africa’s failure to make demonstrable progress on policy requests by the administration” and that South Africa “is a middle-income country and is more than capable of supporting its own health programs.”
The policy requests included that it pare back its partnership with Iran, end Black Economic Empowerment policies, and condemn race-based incitement to violence, including singing of “Kill the Boer”, an anti-apartheid liberation song. Some have interpreted the latter as a call for violence against Afrikaners.
This has left many activists incensed.
“This is a clear and unambiguous reflection of the U.S. government’s irrational foreign policy conflict with a sovereign country that it is seeking to bully but cannot. It makes a mockery of claims made by the U.S. embassy in South Africa that it is concerned about South Africans living with HIV, when really, this shows it is not,” Fatima Hassan of the Health Justice Initiative (HJI) told IPS.
“The U.S. State Department is claiming that because South Africa is a middle-income country, it should be able to pay for its own HIV response. South Africa is actually an upper-middle-income country, but South Africa pays more to its HIV response than any other non-OECD company, and the epidemiology [situation with HIV in South Africa] indicates that because South Africa’s HIV burden is so astronomically higher than any other country that [financial] solidarity is required,” Asia Russell, Executive Director of HIV advocacy group Health Gap, told IPS.
She said the other political reasons reportedly linked to the decision were indefensible and driven by anti-South African political policies based on utterly unfounded claims of, among other things, “the fiction of a white genocide in south Africa” being pushed by some people in the White House.
Meanwhile, those at the frontline of helping people with HIV and stopping the disease spreading say that politics must not get in the way of saving lives and that regardless of what happens with international funding, essential HIV services in South Africa must be ensured.
“The government must immediately assess the impact of funding losses, mobilise domestic resources where necessary, and ensure that no person is denied access to lifesaving healthcare because of donor withdrawal. The HIV epidemic has taught us a painful lesson: when political decisions undermine access to healthcare, people die. South Africa cannot afford a return to the devastating losses of the past, where we buried comrades every weekend. The gains achieved through decades of activism, scientific progress, and public investment must not be sacrificed,” TAC said.
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