U.S. PEPFAR Funding Drawdown Threatens South Africa’s HIV Services

The U.S. State Department announced a phased withdrawal of more than $400 million in annual President’s Emergency Plan for AIDS Relief (PEPFAR) funding to South Africa, to be largely completed by September 2025, with limited personnel support continuing through March 2026.

South African civil groups warn of dire impact as US phases out HIV program funding

Since its launch over two decades ago, PEPFAR has underpinned South Africa’s HIV response, supporting treatment, testing, prevention and community-based services that are credited with saving over 20 million lives.

South African Groups Warn Of Impact From U.S. HIV Funding Cuts

President Donald Trump issued the executive order prompting the cuts; the U.S. State Department set the drawdown schedule; South Africa’s Health Department spokesperson Foster Mohale outlined a self-reliance plan; civil-society group Section27 (senior legal researcher Tendai Mafuma); Anova Health Institute (public-health specialist Dr. Kate Rees); and the WITS Reproductive Health Institute (RHI) are directly involved.

South African civil groups warn of dire impact as US phases out HIV program funding

South Africa has roughly 8 million people living with HIV (?12.7 % of its 63 million population). PEPFAR accounted for about 17 % of the national HIV budget, excluding antiretroviral drug purchases (90 % self-funded, 10 % from the Global Fund). The drawdown affects programs in 27 districts and has already led to the lay-off of roughly 3,000 health workers.

South African civil groups warn of dire impact as US phases out HIV program funding

Civil-society groups warn that women, adolescent girls and other priority populations face the greatest service gaps. Community delivery of pre-exposure prophylaxis (PrEP) and other prevention initiatives has been “heavily impacted,” while treatment continuity is being prioritized over prevention.

South African Groups Warn Of Impact From U.S. HIV Funding Cuts

The State Department linked continued funding to South Africa’s condemnation of “race-based incitement to violence,” including the “Kill the Boer” song. South Africa’s health department cited an existing self-reliance strategy and a $45 million emergency fund launched last year to mitigate the shortfall.

South African civil groups warn of dire impact as US phases out HIV program funding

Section27’s assessment of three high-prevalence districts indicates that prevention services are “hardly hit” only because the system has shifted resources to maintain treatment. Critics argue that reduced outreach could reverse decades of progress, especially among young women and key populations such as men who have sex with men and people who use drugs.

South African Groups Warn Of Impact From U.S. HIV Funding Cuts

In Hillbrow, Johannesburg, a sign at the WITS RHI clinic reads: “USAID has served the WITS RHI Key Populations Programme a notice to pause programme implementation. As of Tuesday, 28 January, we are unable to provide services until further notice.”

South African civil groups warn of dire impact as US phases out HIV program funding

Sources differ on the extent to which prevention versus treatment has been affected, and no comprehensive data are available on long-term outcomes for the 3,000 workers laid off. The timeline for full program cessation beyond September remains unclear.

South African Groups Warn Of Impact From U.S. HIV Funding Cuts

• “USAID has served the WITS RHI Key Populations Programme a notice to pause programme implementation. As of Tuesday, 28 January, we are unable to provide services until further notice.” — WITS Reproductive Health Institute

South African civil groups warn of dire impact as US phases out HIV program funding

• “The department has long been working on a self-reliance plan to minimize the impact of funding withdrawal since the initial freeze on foreign assistance and a cancellation of USAID grants in January 2025,” — Foster Mohale, South Africa Health Department spokesperson

South African civil groups warn of dire impact as US phases out HIV program funding

• “Community delivery of PrEP (preexposure prophylaxis) and prevention services has been heavily impacted,” — Dr. Kate Rees, Anova Health Institute

South African civil groups warn of dire impact as US phases out HIV program funding

• “As the health system started to feel the pressure, the response was to prioritize treatment continuity versus prevention,” — Tendai Mafuma, Section27 senior legal researcher

South African civil groups warn of dire impact as US phases out HIV program funding

• “unequivocally condemn all race-based incitement to violence, including the ‘Kill the Boer’ song, more frequently.” — U.S. State Department spokesperson

South African civil groups warn of dire impact as US phases out HIV program funding

The phased drawdown is slated for completion by September 2025, with residual personnel assistance through March 2026. Civil-society monitors will track service continuity, while the South African government plans to rely on its emergency fund and self-reliance measures to sustain essential HIV care.

South African civil groups warn of dire impact as US phases out HIV program funding