After only two months office, the Trump administration dismantled USAID, a financial lifeline for poorer countries across the globe. This has severely impacted vital aid programmes and placed high risk populations in crisis.
South Africa’s funding was cut by roughly 89%, making it one of the worst-hit African countries. In 2024, the US provided US$453mn (£335mn) in direct funding to South Africa under the President’s Emergency Plan for AIDS Relief (PEPFAR). South African HIV programmes rely heavily on this funding and have been severely impacted.
How PEPFAR tackled the HIV epidemic
PEPFAR was a global health fund set up by the US to tackle the AIDS epidemic. It set up clinics, testing and the distribution of antiretroviral drugs across Africa, reducing AIDS cases across the continent. As a result of the USAID cuts, (which was the main delivery agency for PEPFAR), treatments have been limited and the programme is struggling to maintain a sustainable level of operation.
In recent decades, South Africa has been fighting an HIV epidemic. It has one of the highest rates of HIV in the world; in 2019 there was a prevalence of 19% for adults aged 15 to 49. This does not mean that South Africa is experiencing an equivalent level of AIDS. Anti-retroviral drug programmes across the country have helped to ensure patients’ viral loads (the amount of HIV in the blood) don’t reach the threshold for progression to AIDS. Thanks to these programmes, many of them funded by PEPFAR, an estimated 75% of people living with HIV were receiving antiretroviral therapy in South Africa as of 2022.
In fact, PEPFAR contributed 17% of income for these HIV/AIDS programmes. But since the cuts to USAID, the scale of them has been significantly reduced due to shortages of health workers and resources, limiting testing and treatment capacity. It is estimated that around 8,000 health workers are out of work and 12 specialised HIV clinics with more than 60,000 registered patients have shut down. This will isolate those 60,000 people and possibly more patients, from the necessary treatments, testing and therapies they need to prevent the progression of HIV to AIDS.
Patients in limbo, TB programmes affected
In a recent interview by DW, Nozuko Majola, a young HIV patient in South Africa said, “We used to get the drugs delivered to our homes, but since Donald Trump announced he was cutting aid, the drugs have stopped coming. I’m worried that this service will be cancelled altogether”. Patients across South Africa are filled with similar fears and anxieties, unsure as to whether their next delivery of these life-saving drugs will arrive.
Not only are HIV programmes being affected, the vital research and treatment of Tuberculosis (TB) is also at risk.
Dr Cathy Hewison, head of Médecins Sans Frontières’ TB working group said: “It’s the number one killer of people with HIV.” This is because HIV reduces the efficiency and strength of the immune system, increasing the likelihood of contracting and dying from infections such as TB. South Africa had a TB incidence rate of 427 per 100,000 people in 2023 down from 57% in 2015. The government is insistent that it won’t let the recent aid cuts undo years of work against TB.
Research programmes on the brink
Alongside HIV and TB treatment programmes, South Africa is a critical centre for research and development into vaccines and new medicines for both diseases. The Treatment Action Group (TAG) claims around 39 clinical research sites, at least 20 TB trials and 24 HIV trials are at risk. This would damage years of studies into these diseases; stall crucial trials and halt progress towards improving the lives of millions of people affected by TB and HIV.
USAID was an indispensable organisation and the cuts have endangered healthcare provision in South Africa. There is uncertainty among communities as to whether they will receive treatment, workers are out of jobs as clinics are shut down and researchers have been left stranded with their funding pulled. Without the US contributions the country has relied on for years, the government is struggling to provide adequate services and treatments to HIV patients across the country.
Healthcare aid vacuum: who will step in?
South Africa is just one of many countries damaged and exposed by the USAID cuts: Afghanistan’s food aid has been reduced, Ethiopia has experienced health programme delays, peacebuilding efforts in South Sudan have been halted and in Bangladesh, education initiatives have been slowed. Many more countries have suffered at the hands of the Trump administration.
What is the future for the affected countries? They have a hole in their funding which ultimately requires intervention to allow for development and growth. Some governments are attempting to move away from reliance on foreign funding, instead trying to find solutions within the country to maintain these programmes. In South Africa, the government has prioritised funding healthcare and collaborated with NGOs and private corporations to ensure HIV patients are not isolated by the cuts.
On the other hand, countries such as China may try to capitalise on the US absence, increasing their control and advancement towards becoming the next global superpower.
No matter what, these countries should not be left without aid and supplies – drowning under the needs of people which cannot be met with existing resources. Access to adequate healthcare is a human right; a right which is currently being denied to patients in South Africa.
