The chief science officer for PEPFAR — the US government's flagship HIV/AIDS programme — resigned in April 2026 and warned that funding cuts and the use of health aid as political leverage risk reversing two decades of progress against HIV in Africa.
Mike Reid, a practising infectious disease physician who served as chief science officer for PEPFAR in the State Department's Bureau of Global Health Security and Diplomacy, published his resignation post on Substack on 20 April. He told Reuters the State Department ended his employment immediately after seeing the post.
What happened
President Donald Trump dismantled the US Agency for International Development (USAID) in 2025. USAID had previously overseen most US foreign aid programmes, including much of the logistics behind PEPFAR. Officials said PEPFAR's life-saving work — mainly in developing African nations — would continue under the State Department.
Reid stayed in his role for 18 months after the restructuring, hoping to preserve at-risk programmes. He left when he concluded that the administration was using health funding as leverage over developing countries.
The Zambia case
Reid cited a New York Times report from March 2026 stating that the State Department was considering withholding HIV assistance to Zambia in order to push the country to sign a favourable critical-minerals deal with the United States.
"When access to treatment or prevention becomes entangled with access to critical minerals or geopolitical positioning, the work is no longer what it claims to be." — Mike Reid, former chief science officer, PEPFAR
The data
The State Department published data showing that the number of people being tested for HIV dropped sharply in 2025 amid interruptions to PEPFAR. PEPFAR has been credited with saving 26 million lives and preventing HIV infections in 7.8 million babies born to HIV-infected mothers since it began in 2003 under President George W. Bush.
Reid also told Reuters that moving funding from NGOs to government health bodies was the right approach in principle — but that it was happening after many of the US officials who previously monitored for corruption and misuse of funds had lost their jobs. "I am concerned at the speed and the lack of oversight," he said.
What the State Department says
A State Department spokesperson said the department is continuing to spend the money Congress appropriated for PEPFAR, and that it had offered Zambia a "generous multi-year package of US assistance." The spokesperson did not address the claim that the US sought economic concessions in exchange.
The spokesperson said Reid departed by mutual agreement after he "admitted he could no longer provide nonpartisan scientific advice." They added that Trump and Secretary of State Marco Rubio were "building to end the HIV/AIDS epidemic as they champion the transformational work happening under the America First Global Health Strategy."
Why this matters for South Africa
South Africa is the largest recipient of PEPFAR funding in the world. PEPFAR has supported antiretroviral treatment for millions of South Africans and has been central to the country's progress against HIV over the past two decades.
Any disruption to that funding affects the same public clinics that deliver the treatment discussed in this week's other story — the ones now using ITREMA-2 to more efficiently manage drug resistance. The two stories are connected: innovation in how South Africa delivers HIV care is happening at the same time as the funding that supports that care is under pressure.
What comes next
It is not yet clear how the funding reductions will affect specific South African programmes. The State Department says bilateral agreements with governments include "extensive new government-to-government accountability and compliance frameworks," but Reid's resignation letter and Reuters reporting suggest that the transition is happening faster than the oversight systems can adapt.
For people living with HIV in South Africa, the practical question is whether treatment access remains stable. For now, the programmes continue. But the trendline — reduced funding, reduced testing, reduced oversight — is a concern that HIV advocates are watching closely.
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