U.S. Cuts Lifeline: PEPFAR's HIV Funding Exit Leaves South Africa in Crisis

The U.S. is phasing out its major HIV funding programme in South Africa. PEPFAR, which supported prevention and treatment services, will end most operations by September 2025. The withdrawal follows a political dispute between the two governments. In January 2025, U.S. President Donald Trump halted financial aid to South Africa. He cited concerns over Black Economic Empowerment policies and land expropriation laws. The U.S. State Department also demanded that senior South African officials condemn the song 'Kill the Boer' as a condition to avoid the withdrawal.

PEPFAR previously covered about 17% of South Africa’s HIV programme budget, excluding antiretroviral drugs. The country has the world’s largest HIV-positive population, with around 8 million people affected. Prevention services have suffered the most, with children, adolescents, and other key groups facing the greatest impact.

Some HIV support centres have already closed. Front-line workers and volunteers have lost their jobs as funding dried up. Civil society groups report that adolescent girls and women are among the first to feel the effects of the cuts.

Since January 2025, South Africa’s health department has worked on a self-reliance plan to reduce the damage. In 2024, the government also set aside a $45 million emergency fund to fill gaps left by PEPFAR’s departure. The phase-out of PEPFAR will leave a significant funding gap in South Africa’s HIV response. Prevention programmes and support services have already been disrupted. The government’s emergency measures aim to soften the impact on vulnerable groups.