In August 2026, UNAIDS warned that HIV infections could rise as global aid declines. A study across 47 countries found significant drops in community-led services, including a 50% reduction in support for prevention medicines and HIV care. Donor government funding fell by 25%.
South Africa is the largest recipient of PEPFAR funding in the world. What happens to that funding matters more here than anywhere else.
What PEPFAR does
The President's Emergency Plan for AIDS Relief (PEPFAR) began in 2003 under President George W. Bush. Since then, it has been credited with saving 26 million lives and preventing HIV infections in 7.8 million babies born to HIV-infected mothers.
In South Africa, PEPFAR supports:
- Antiretroviral treatment for millions of people
- Testing and diagnosis programmes
- Prevention medicines (PrEP and the new lenacapavir injection)
- Community health worker programmes
- Orphaned and vulnerable children's programmes
- Data collection and clinic infrastructure
What has changed
In 2025, the Trump administration dismantled the US Agency for International Development (USAID), which had overseen much of US foreign aid logistics. Officials said PEPFAR's work would continue under the State Department.
In April 2026, the chief science officer for PEPFAR, Mike Reid, resigned and warned that the administration was using health funding as political leverage over developing countries. He cited a New York Times report that the State Department was considering withholding HIV assistance to Zambia to push for a favourable critical-minerals deal.
State Department data shows the number of people being tested for HIV dropped sharply in 2025 amid the restructuring.
What this means for South Africa
For people living with HIV in South Africa, the practical effects are still unfolding:
- Treatment access. For now, medication supply remains stable. The South African government funds most first-line treatment through its own budget. But PEPFAR has supported second-line and third-line regimens, and any interruption to those would affect people whose first-line treatment has failed.
- Prevention. The lenacapavir rollout is funded partly through PEPFAR. If that funding is reduced, the rollout could slow.
- Testing. Fewer testing programmes means more late diagnoses. Late diagnosis is associated with worse outcomes and higher transmission risk.
- Community programmes. NGOs that provide testing, counselling, and support are heavily PEPFAR-dependent. Many have already reduced services.
What the government says
The South African National Department of Health has stated publicly that it is committed to maintaining HIV treatment regardless of donor funding changes. Historically, South Africa has increased its own HIV budget when donor funding has declined.
But community organisations and advocates warn that the government cannot fully replace PEPFAR's contribution, especially for community-led programmes that reach people who do not access formal clinics.
What you can do
If you are on HIV treatment, keep taking it. If you are on prevention, keep using it. If you need to test, test. Do not let funding uncertainty change your own decisions.
Beyond that, if you are in a position to do so:
- Support community HIV organisations directly
- Advocate to your local government representatives about HIV funding
- Share accurate information — misinformation about PEPFAR cuts has caused real anxiety among people who depend on its services
Haven is a dating and community app built for the HIV+ community in South Africa.
Get Haven on Google Play