Africa: 'What Is the Plan?' - Inside South Africa's Reckoning With a Post-PEPFAR World

What the report says

AllAfrica reports that anxiety over reduced U.S. support for HIV programmes dominated a session at the International AIDS Conference in Rio de Janeiro, where South African healthcare worker Belinda Tewela described longer clinic waits, staffing shortages and declining service quality after organisations that had helped fill gaps withdrew. Tewela, who lives with HIV, asked what plan exists to prevent a return to widespread AIDS-related deaths.

The report focuses on South Africa’s exposure to cuts in the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR. South Africa funds most HIV medicines and runs the world’s largest HIV treatment programme, but AllAfrica notes that PEPFAR has long supported health workers, community groups, prevention work, research and services for key populations. Health officials, researchers and advocates warned that the contraction is already affecting clinics and community services.

AllAfrica cites KFF and UNAIDS data showing donor government funding for HIV programmes in low- and middle-income countries fell by US$2.1 billion in 2025, a 25% drop from the previous year. Kenneth Ngure, IAS president-elect and a Kenyan researcher, said recent disruption has affected treatment, prevention, testing, research and staffing, including 77,000 fewer children receiving supported HIV treatment in fiscal 2025 than the year before. He also raised concerns about new bilateral funding agreements with Washington, including questions over data, privacy and sovereignty.

Mark Reid, a former PEPFAR science chief, said the rapid and opaque transition risks weakening systems needed to deliver new prevention tools. The broader issue, as presented in the report, is whether African governments can increase ownership of HIV responses without abrupt donor withdrawal undermining services first.