What we know so far
The United States has confirmed it will begin a phased withdrawal of funding for South Africa’s HIV programmes, ending one of the world’s largest health partnerships.
A US State Department official confirmed on Thursday, 18 June 2026, that Washington had decided to start a phased drawdown of the President’s Emergency Plan for AIDS Relief, known as PEPFAR, in South Africa. The official said the decision followed South Africa’s failure to make demonstrable progress on policy requests by the administration.
The same official argued that PEPFAR was never intended to be permanent and that South Africa, as a middle-income country, was capable of supporting its own health programmes.
According to congressional aides briefed on the decision and quoted by the news outlet that first reported it, the administration aims to close out PEPFAR programming in South Africa by early 2027. Programme awards are expected to wind down later this year, while some support for healthcare workers continues into 2027.
US Ambassador Leo Brent Bozell III is expected to meet officials from South Africa’s Ministry of Health in the days ahead to formally communicate the decision.
Why it matters
South Africa carries the heaviest HIV burden in the world. Health Minister Dr Aaron Motsoaledi told Parliament’s Portfolio Committee on Health in February 2025 that approximately 7.8 million South Africans are living with HIV, the highest number of any country.
PEPFAR has been a pillar of the national response for more than two decades. The programme has funded testing, prevention, treatment support, and a large frontline health workforce, concentrated in 27 high-burden districts identified by the Department of Health.
The South African government has consistently stressed that the most critical element of treatment is not directly dependent on US money. The health ministry’s position is that life-saving antiretroviral medicines are procured separately and financed largely through the national budget.
Motsoaledi told Parliament that the government funds the large majority of its HIV and AIDS programmes, including antiretroviral drugs, with most healthcare workers managing HIV care paid from the national fiscus rather than by PEPFAR.
The withdrawal still removes a significant layer of support. Civil society groups and opposition parties have warned that the loss of PEPFAR-funded staff and services could disrupt prevention and treatment in the districts most reliant on that assistance.
Key details and figures
The State Department official said the drawdown stems from unmet conditions tied to an executive order signed by President Donald Trump in February 2025. That order accused the South African government of permitting discrimination against the white Afrikaner minority. The South African government disputes this characterisation and defends its Black Economic Empowerment policy as a measure to correct apartheid-era inequality.
Congressional aides cited additional demands raised with Pretoria, including reducing its partnership with Iran, ending Black Economic Empowerment policies, and addressing the “Kill the Boer” chant. One Senate aide quoted in the reporting said none of these requests related to health, describing them as political.
On the funding scale, the figures tell the story of a steady decline. The Democratic Alliance, citing official data, has stated that South Africa received about $453 million in PEPFAR funding in 2024, with roughly $439 million allocated for 2025.
PEPFAR has historically provided an estimated $400 million a year to South Africa’s HIV response. The State Department reports that the programme has channelled more than $8 billion to the country since its launch under President George W Bush in 2003.
The proportion of South Africa’s HIV budget covered by PEPFAR has been put at roughly 17 to 18 percent by several sources, with the BBC reporting it represented about a fifth of total HIV spending.
After the initial 2025 disruptions, the programme received a temporary reprieve. The State Department approved a PEPFAR Bridge Plan worth $115 million, running from 1 October 2025 to 31 March 2026, administered through the US Centers for Disease Control and Prevention. That bridge period has now ended. Reporting on the latest decision indicates South Africa has received only about $25 million for HIV efforts so far in 2026.
The National Treasury has already moved to fill part of the gap left by earlier cuts. Motsoaledi announced during the 2025/26 health budget vote that Treasury would release about R753 million to help cover the shortfall, an amount equivalent to roughly $42 million at prevailing exchange rates and far below what US funding had provided.
A note on the headline figure: the health minister’s parliamentary figure of 7.8 million people living with HIV is used here as the primary source. Some institutions, including Statistics South Africa data cited by the Democratic Alliance, place the figure closer to 8 million, at a national prevalence of around 12.7 percent.
What happens next
The immediate next step is the planned meeting between Ambassador Bozell and the Ministry of Health, at which the decision is expected to be formally delivered.
The structure of the wind-down remains the key open question. Available reporting indicates that programme awards will be reduced this year, with some healthcare worker funding continuing into 2027 before a full closeout. The Department of Health has not yet published a detailed transition plan responding specifically to the 18 June confirmation.
Domestic financing will determine the real-world impact. Treasury’s earlier R753 million allocation covers only a fraction of the historical US contribution, and the health department has previously sought additional emergency funding under the Public Finance Management Act.
Modelling commissioned by the National Health Department and conducted by researchers at the University of Cape Town and the University of the Witwatersrand has projected that the loss of PEPFAR support could lead to a substantial rise in new HIV infections by 2028 unless the government covers the defunded services.
Whether South Africa can absorb the loss without service disruption now depends on how quickly Treasury, the health department, and external donors mobilise replacement funding before US support is fully withdrawn.
