Overview
- The U.S. has started a phased drawdown of PEPFAR support that has provided about $400 million a year to South Africa, and the State Department says most programs will end by Sept. 30, 2026 with critical personnel support through March 31, 2027.
- PEPFAR funding covered prevention programs, community outreach, data systems and many frontline salaries rather than the purchase of most antiretroviral drugs, which South Africa buys itself.
- Civil-society groups and providers report immediate harm: prevention services and community delivery of PrEP have been curtailed, some facilities have closed and Anova has laid off about 3,000 health workers since last year.
- UNAIDS chief Winnie Byanyima and other U.N. officials warn an unmanaged withdrawal could cost lives and reverse progress for more than eight million people living with HIV in South Africa.
- Washington says the cuts are tied to political demands of Pretoria, and South Africa says it has a self-reliance plan and a $45 million emergency fund but that gaps remain that could impede rollout of new prevention tools and raise infection risks.