emma choe

“Not long ago, we said by 2030, we want to see an HIV-free generation. But if things remain as they are, we will not achieve that. We will have to deal with deaths.”
— Nozuko Ngcaweni, a South African woman living with HIV for nearly 30 years (AP News, 2025)

For decades, South Africa has stood as a frontline battleground in the global fight against HIV/AIDS. Now, that fight is in jeopardy. In early 2025, the Trump administration enacted sweeping cuts to U.S. foreign aid, including a dramatic rollback of the President’s Emergency Plan for AIDS Relief (PEPFAR). As clinics close, treatments are interrupted, and prevention programs stall, experts warn that the progress made over the last two decades is at risk of unraveling—along with millions of lives.

A History of United States HIV/AIDS Support in South Africa

PEPFAR, launched in 2003, has been one of the largest and most influential global health initiatives in history, investing over $110 billion in efforts to combat HIV/AIDS worldwide. (PEPFAR, 2023) South Africa, home to the world’s largest population of HIV-positive individuals, has been one of the program’s key beneficiaries. With approximately 7.8 million people living with HIV in the country, PEPFAR funding has been essential in providing antiretroviral therapy (ART)— medications that reduce the viral load in people living with HIV to undetectable levels. ART not only prevents the progression of HIV to AIDS but supports community outreach, and strengthens local healthcare systems.

Over the years, the program has contributed to significant improvements in public health. For instance, Life expectancy has increased, mother-to-child HIV transmission rates have fallen, and the number of HIV-related deaths has decreased substantially. For many South Africans, access to PEPFAR-funded healthcare has been the difference between life and death. The program has been an indispensable part of the country’s HIV response, playing a vital role in both prevention and treatment.

The Impact of Funding Cuts

The cuts to foreign aid from the United States, which include a reduction of nearly $880 million from global vaccine initiatives and $262 million from UNAIDS, will severely impact the efforts made to control HIV/AIDS. With PEPFAR funding reduced, South Africa has faced the closure of clinics, interruptions to ART distribution, and the cessation of key prevention and outreach programs. These cuts threaten to reverse years of progress and place millions of lives in jeopardy.

Reports from health organizations indicate that without immediate action, South Africa could see an increase of over half a million new HIV infections and nearly 600,000 additional AIDS-related deaths over the next decade. The most vulnerable—particularly young women and gay men—are bearing the brunt of the impact.

Already, many healthcare facilities are struggling to maintain services. Some have been forced to cut back on essential treatments, while others are operating with limited staff due to the loss of funding. As a result, the most vulnerable populations are increasingly at risk of losing access to life-saving HIV medications and prevention efforts.

Political and Economic Fallout

The United States’ funding cuts have placed immense pressure on South Africa’s domestic healthcare system, which is already grappling with economic constraints. The South African government, despite its commitment to fighting HIV/AIDS, lacks the financial resources to replace the lost funding. These limited resources lead public health infrastructure to be stretched thin The additional burden of PEPFAR’s retreat only further exacerbates the crisis.

[Moreover, the decision to reduce funding has strained diplomatic relations between the U.S. and South Africa. South African leaders have expressed frustration, viewing the cuts as a betrayal of the international commitment to combat HIV/AIDS.] The cuts not only threaten the progress made in South Africa but also undermine global health efforts, sending a dangerous message about the future of international cooperation in the fight against HIV/AIDS.

Searching for Alternatives 

In response to the crisis, global health organizations and advocacy groups have been scrambling to fill the gap left by PEPFAR’s funding reductions. The Global Fund, the Bill & Melinda Gates Foundation, and regional governments have all sought to step in. Unfortunately, these efforts have been limited due to the scale of the funding cuts. While some temporary funding has been secured, the loss of PEPFAR’s long-term support remains a significant obstacle in South Africa’s ability to sustain its HIV/AIDS programs. 

South African healthcare workers and activists are also working to raise awareness of the situation and mobilize potential alternative sources of funding such as domestic budget reallocations and philanthropic foundations. As the health crisis deepens, there are concerns that temporary solutions will not be enough to reverse the damage caused by the funding reductions. 

The Road Ahead

Although the future of PEPFAR funding remains uncertain, the consequences of the cuts could be dire not just for South Africa but for the broader global fight against HIV/AIDS. The reduction in funding has led to a slowdown in treatment and prevention efforts, and without a significant restoration of funding, the progress made over the last two decades could be lost. 

Global health advocates have called for a reversal of the funding cuts, but political divisions in the United States have made it unclear whether these calls will be heeded. The outcome will have profound implications for not just South Africa, but for countries around the world where HIV/AIDS remains a significant threat to public health. 

As South Africa faces this growing crisis, the international community must recognize the urgency of the situation. The progress made in combating HIV/AIDS is fragile, and any setback could result in catastrophic consequences. With millions of lives at stake, it is imperative that global support for HIV treatment and prevention continues, and that the lessons learned over the past two decades are not lost.