By Lehlohonolo Lehana.
The sudden decision by United States President Donald Trump to halt and review all foreign aid for 90 days could be devastating for HIV programmes in African countries.
After Trump’s inauguration on 20 January, he signed numerous executive orders. One of these suspends aid to “foreign countries and implementing non-governmental organisations, international organisations, and contractors” pending review for whether it aligns with “American interests and … values”.
The order said, “no further [US] foreign assistance shall be disbursed in a manner that is not fully aligned with the foreign policy of the President of the United States”.
South Africa is one of the many developing countries around the world which receives aid through President’s Emergency Plan for Aids Relief (PEPFAR).
Speaking at an African National Congress (ANC) media briefing on Tuesday afternoon, Health Minister Dr Aaron Motsoaledi said that his department had started collating data on the institutions that will be affected.
“We are running the world’s biggest HIV counselling and testing campaign and at least 5.5 million people are on ARVs and no other country comes close to that. The total amount spent on this campaign is R44.4 billion and PEPFAR contributes 17%.”
He added that they were still trying to ascertain the extent of the problem the health department is about to face.
“Most of the people funded by Pepfar told us that they have been written letters to stop because of the review. We, as the government, have not received any letter whatsoever. We hear from the clinics, especially WITS … We will compile and finalise the matter.”
A number of the country’s clinics have already started rolling back their operations in anticipation of the funding freeze.
The Wits Reproductive Health and HIV Institute (Wits RHI), a renowned research centre dedicated to HIV, sexual and reproductive health, and vaccine-preventable disorders, announced the closure of its clinic until further notice.
“We sincerely apologise for the inconvenience this may cause and remain committed to your health and wellbeing,” the institute said.
South Africa has about 5.6 million people on antiretroviral treatment. The medicines themselves are paid for by the South African government, but Pepfar funds some of the staff at some ARV programmes. It also funds much of the prevention and information effort, including ARV user clubs, medical circumcision and public messaging.
South Africa does leading research on HIV and TB. Much of this is funded by the US National Institutes of Health. It’s unclear what the future status of this funding is.
A study from 2024 looking at the rate of mortality amongst South African adults who experienced interruption in antiretroviral treatment, shows that interrupting antiretroviral treatment leads to much greater risk of death.
It is unclear how Trump’s order to pause and review foreign aid will affect Pepfar in the future. The US Agency for International Development (USAID) media office did not respond to questions by the time of publication.
Trump also issued an executive order withdrawing the United States from the World Health Organisation (WHO). According to Reuters there is a 12-month notice period for the US, the WHO’s largest funder, to leave the organisation and stop all financial contributions to its work.