The United States plans to gradually cut off funding for HIV and AIDS programs in South Africa, a decision that could shake one of the largest public health partnerships in the world. The move comes as relations between Washington and Pretoria keep deteriorating, and US officials have tied it directly to disagreements over South Africa’s domestic and foreign policies.
This isn’t a small adjustment. The funding has backed South Africa’s fight against HIV for more than 20 years. Health experts warn that pulling it could hurt prevention, testing, and treatment efforts, even though South African officials say they’ve been preparing for this for years.
The announcement adds one more strain to a relationship that’s already rocky under President Donald Trump.
South Africa Carries the World’s Heaviest HIV Burden
More than eight million South Africans live with HIV, more than any other country, according to health officials and international health organizations.
For decades, the US helped carry that load through PEPFAR, the President’s Emergency Plan for AIDS Relief. Before 2025, PEPFAR sent roughly $400 million a year into South Africa for prevention, treatment, outreach, testing, and healthcare infrastructure. That’s about a fifth of everything South Africa spends on HIV and AIDS.
PEPFAR has saved millions of lives across Africa and other hard-hit regions since it launched in 2003. Pulling funding from South Africa raises a bigger question too: what happens to other countries that depend on the same program.
Washington Ties the Cut to Policy Disputes

A State Department official said the phased withdrawal is happening because South Africa hasn’t made enough progress on issues the Trump administration has raised. Those issues include race, land ownership, economic policy, and South Africa’s international relationships.
Soon after taking office, Trump signed an executive order accusing South Africa of running policies that discriminate against certain groups, specifically white Afrikaners. The White House argues some of South Africa’s policies unfairly target white landowners and stoke social tension.
South African officials reject that framing entirely. They say their policies exist to fix economic inequalities that apartheid left behind decades ago and that haven’t gone away on their own.
Black Economic Empowerment at the Center of It
Much of the disagreement centers on South Africa’s Black Economic Empowerment program, which is designed to bring more Black South Africans and other historically excluded groups into the economy.
South African leaders argue the policy is necessary. Apartheid-era laws kept the Black majority out of land ownership, business, and wealth building for generations, and that gap hasn’t closed. Critics in the US, along with some South African opposition figures, argue parts of the program create new forms of discrimination instead of fixing old ones.
Pretoria has defended the program repeatedly, calling it essential in a country where wealth is still concentrated in very few hands.
The White House Objects to South Africa’s Foreign Policy Too
The criticism doesn’t stop at domestic policy. The Trump administration has also pushed back on South Africa’s foreign policy choices, particularly its case against Israel at the International Court of Justice and its diplomatic ties with Iran.
US officials say these moves show South Africa working against American interests and the interests of close US allies. In a statement explaining the funding decision, the White House said it couldn’t justify continued financial support given what it called “unjust and immoral practices.”
South Africa rejects the accusation. The government says its foreign policy is grounded in international law and its own national interests, not hostility toward the US.
Claims of Afrikaner Persecution Add Fuel
Trump has repeatedly claimed that white South Africans face widespread persecution, going so far as to call it a “white genocide.” South African authorities, independent researchers, and international observers have rejected that claim.
Violent crime is a real and serious problem in South Africa, but it affects communities across racial lines, not one group specifically. Still, the administration’s position led to a special US refugee program for Afrikaners, descendants of Dutch, German, and French settlers who arrived in southern Africa centuries ago. That program has drawn international attention, since Afrikaners are now one of the few groups getting special refugee treatment under current US immigration rules.
South African leaders call the program politically motivated and say it doesn’t reflect what’s actually happening on the ground.
South Africa Says It’s Ready to Stand on Its Own
South Africa’s Health Ministry has tried to calm public concern. Officials say they haven’t received formal notice of the funding decision, but they’ve spent years building toward less reliance on foreign aid.
The ministry points out that most of the country’s supply of antiretroviral medication is already paid for domestically. South Africa funds the majority of its HIV treatment program through its own national budget, not PEPFAR. Officials say the long-term goal has always been a healthcare system that doesn’t depend on outside donors.
That said, public health experts caution that replacing hundreds of millions of dollars a year won’t be simple, especially in areas like community outreach, prevention campaigns, and the support services that help patients stay on their medication.
Efforts to Patch Things Up Haven’t Worked
The past year has brought several attempts to repair the relationship between Washington and Pretoria, and none have landed.
The most visible attempt came during a White House meeting between Trump and South African President Cyril Ramaphosa, where Trump confronted Ramaphosa directly over claims about the treatment of white South Africans. People watching hoped it would ease tensions. It didn’t. The disagreements that mattered most stayed unresolved, and since then the relationship has kept sliding, with new disputes piling up over trade, foreign policy, race, and international security.
What Happens to HIV Care Now
The bigger question is what happens to people who depend on these programs every day.
Government officials say treatment will continue. Healthcare organizations aren’t so sure that’s the whole picture. They warn that losing this funding could hit testing services, community health programs, education campaigns, and the support systems that keep patients on their medication consistently.
For the millions of South Africans living with HIV, none of the diplomatic back-and-forth matters as much as one thing: whether their access to care stays uninterrupted. As the funding drawdown begins and tensions between the two countries keep rising, that’s the part South Africa has to protect, even while the rest of the relationship falls apart around it.















