The United States (US) is to begin a “phased drawdown” of support for HIV treatment in South Africa, through the President's Emergency Plan for AIDS Relief (PEPFAR). This is according to comments made by an unnamed State Department official reported in US media.

PEPFAR is an initiative launched during the Presidency of George W Bush in 2003 to provide support for recipient countries to deal with the HIV pandemic. Its activities have been particularly targeted at sub-Saharan Africa; according to US government information, by 2024 the programme had saved some 26 million lives across 55 countries.

South Africa, with one of the highest HIV burdens in the world, was a major beneficiary of the programme. In 2024, it received some $456 million from the US for HIV-related work, although this was reduced to $213 million in 2025, after the US introduced extensive cuts to foreign aid. Over the life span of PEPFAR, it had provided some $8 billion to South Africa.

“The United States has decided to initiate a phased drawdown of PEPFAR programming in South Africa following South Africa’s failure to make demonstrable progress on policy requests by the administration,” the State Department official reportedly said, adding that PEPFAR could be closed in South Africa by early 2027. The US Ambassador to South Africa, Leo Brent Bozell III, would probably be meeting with South African officials in the coming week to convey the news.

The policy requests, although unspecified in this context, appear to relate to well-known requests by the US government for South Africa to ameliorate its race-based economic policies for US firms operating in the country, to pursue at least genuine non-alignment in foreign policy, to deal with farm murders, and to condemn the “Kill the Boer” chant.

While none of these is health-related, they demonstrate both the explicit linkages the US draws between its national interests and its engagement with foreign countries, and the consequences of South Africa’s domestic policies and global activism.

The official added that South Africa’s authorities had repeatedly been warned that continued access to PEPFAR funding would depend on progress on making the changes demanded by the US administration.

Besides, the official argued that “South Africa is a middle-income country and is more than capable of supporting its own health programmes.”

The Common Sense has previously noted that the US is deeply invested in a commercial partnership with South Africa, but that South Africa’s ideological stance has made this difficult, by adopting extremely hostile positions in respect of key US interests.