Key facts
- U.S. is phasing out over $400 million annually in PEPFAR funding for South Africa's HIV programs.
- The withdrawal is expected to be completed by the end of September.
- South Africa has the highest number of people living with HIV globally, with approximately 8 million affected.
- Reasons cited by the U.S. include South Africa's economic policies and its stance on the Israel-Gaza conflict.
- HIV prevention services and community delivery of PrEP have been significantly impacted, leading to job losses.
Civil society organizations in South Africa have expressed grave concerns regarding the phased withdrawal of U.S. funding for HIV programs, warning that adolescent girls and women are among the most vulnerable groups to be affected. The U.S. State Department confirmed the drawdown of the President’s Emergency Plan for AIDS Relief (PEPFAR), a program that has provided over $400 million annually and is credited with saving millions of lives over two decades.
The phase-out is slated for completion by the end of September, with critical personnel support continuing until March 2026. South Africa, which has the highest number of people living with HIV globally with approximately 8 million individuals, faces significant challenges as a result of these cuts. The U.S. administration cited political issues, including South Africa's Black Economic Empowerment policies, land expropriation laws, and its stance against Israel at the International Court of Justice, as reasons for the funding halt. The State Department indicated that PEPFAR would be withdrawn unless South Africa unequivocally condemned race-based incitement to violence.
While South Africa's government self-funds the majority of its antiretroviral drug purchases, other HIV-related programs across 27 districts have been adversely impacted. This has led to the closure of some support facilities and job losses for front-line workers and volunteers. The country has allocated a $45 million emergency fund to mitigate these impacts. Civil society groups like Section27 have reported that prevention services have been particularly hard-hit, with a shift in focus towards ensuring treatment continuity. Organizations such as the Anova Health Institute have already discontinued PEPFAR-funded programs, resulting in the layoff of around 3,000 health workers, impacting the community delivery of pre-exposure prophylaxis (PrEP) and other prevention services, especially for key populations.