South Africa to Lose PEPFAR Funding

According to a Semafor Africa story by Adrian Elimian & Nicholas Wu, SA is in for more hard times as the Trump Administration announces a permanent end to USA funding for the President’s Emergency Plan for AIDS Relief, or PEPFAR for South Africa only.

While global health organizations have flagged a broader shift in the administration’s global health strategy toward bilateral commercial relationships rather than grant-based funding, this specific, total cut target reported by Semafor is aimed directly at South Africa.

US President Donald Trump’s administration plans to permanently end funding for the President’s Emergency Plan for AIDS Relief, or PEPFAR, in South Africa, according to a State Department official and two congressional aides briefed on the decision.

“The United States has decided to initiate a phased drawdown of PEPFAR programming in South Africa following South Africa’s failure to make demonstrable progress on policy requests by the administration,” the State Department official told Semafor.

The aides said that State Department officials confirmed this week that the administration is aiming to close out PEPFAR, the US global initiative to fight HIV/AIDS, in South Africa by early next year. US Ambassador Leo Brent Bozell III is expected to meet with officials from South Africa’s Ministry of Health as soon as next week to deliver the news.

PEPFAR has provided over $8 billion to South Africa since its founding under President George W. Bush. South Africa has about 8 million people living with HIV, the most in the world. The Senate aide said PEPFAR funds to healthcare workers will continue into 2027 while program awards will wind down later this year.

A Senate aide said State Department officials, when pressed, cited unmet conditions placed on South Africa as justification for the decision — including demands that Pretoria reduce its partnership with Iran, end Black Economic Empowerment policies, and address the “Kill the Boer” anti-apartheid chant. “None of these asks have anything to do with health,” the aide argued. “They’re all political.”

When asked whether the administration had conducted or planned an impact assessment of ending the program, the aide said administration officials replied they would “consider it.”

The State Department official argued “PEPFAR was never intended to be permanent” and that “South Africa is a middle-income country and is more than capable of supporting its own health programs.”

US-South Africa relations have deteriorated since the start of the second Trump term. The US has accused South Africa of carrying out a “genocide” of its white population.

The countries have also squabbled over Pretoria’s affirmative action policies and a genocide case against Israel at the International Court of Justice. The administration expelled South Africa’s ambassador in Washington last year and hosted Afrikaner refugees it described as fleeing persecution.

An expert familiar with the issue told Semafor that ending PEPFAR funding to South Africa “could be catastrophic” without replacement. The move could cause a “cascading effect” leading to “a resurgence of HIV,” they said.