Johannesburg – US President Donald Trump is facing fierce condemnation for slashing foreign aid, particularly to HIV/AIDS programmes in Africa, with health experts warning of potentially catastrophic consequences. In a move that has sparked outrage and disbelief, Trump dismissed Lesotho, a southern African nation heavily reliant on US aid, as a country "nobody has ever heard of" while defending the cuts.
During an address to Congress, Trump highlighted past US aid projects, singling out Lesotho in a dismissive tone. "Eight million dollars to promote LGBTQI+ in the African nation of Lesotho," Trump said, struggling with the pronunciation. "Which nobody has ever heard of," Trump added, as Republican lawmakers laughed.
Lesotho, a landlocked constitutional monarchy, has one of the highest rates of HIV/AIDS in the world. The United States has committed more than $630 million since 2006 to combat the epidemic in Lesotho, providing medication and support, including raising awareness among sexual minorities who face significant stigma. The US also signed a $300 million deal last year to bolster health and crop production through the Millennium Challenge Corporation, which rewards developing countries that meet standards on democracy and good governance.
Trump's administration has cancelled over 90% of US foreign assistance, arguing it is not in the US interest and that the money would be better used for tax cuts. Under the influence of Elon Musk, Trump has effectively shut down the US Agency for International Development (USAID). Trump's first term was marked by a lack of interest in Africa, infamously using an epithet to describe immigrants from the continent.
Lesotho's Government Responds with Shock and Disappointment
Lesotho's government has expressed its shock and disappointment at Trump's remarks. A spokesperson for the foreign affairs department told the BBC that Lesotho enjoyed "warm and cordial" relations with the US.
Lesotho is a significant beneficiary of the US's African Growth and Opportunity Act (Agoa), which provides preferential trade access to promote economic growth. In 2024, the two countries traded goods worth $240 million, primarily exports from Lesotho to the US, particularly textiles and clothing.
Foreign Affairs Minister Lejone Mpotjoane described Trump's comments as "shocking," stating that it was "shocking" to hear a head of state "refer to another sovereign state in that manner."
"To my surprise, 'the country that nobody has heard of' is the country where the US has a permanent mission," Mpotjoane told the BBC. "Lesotho is a member of the UN and of a number of other international bodies. And the US has an embassy here and [there are] a number of US organisations we've accommodated here in Maseru." He later told AFP that they would send an official protest letter to Washington, adding: "We are not taking this matter lightly."
Officials dismissed Trump's remarks as "off the cuff" and a "political statement," adding that they were "uncalled-for" given the good relations between the two nations.
Mpotjoane confirmed that Lesotho had been affected by Trump's decision to pause aid funding. Many organisations were thrown into chaos after the Trump administration announced a permanent end to the US President's Emergency Plan for Aids Relief (Pepfar) funding as part of a wider cost-cutting drive.
Millions at Risk: Experts Warn of Devastating Impact on HIV/AIDS Programmes
The decision to slash funding to HIV/AIDS programmes in Africa has sparked widespread alarm. Health experts and aid organisations warn that these cuts could lead to hundreds of thousands, if not millions, of preventable deaths.
Bekker made the statement after many South African aid groups were notified by the US Department of State that their grants under USAID had been cancelled, stating that the grants no longer aligned with “US priorities” and would be terminated for the “convenience and the interest of the US government”.
“We will see lives lost,” the official said. “In excess of half a million unnecessary deaths will occur because of the loss of the funding, and up to a half a million new infections.”
The United Nations has reported that HIV services in many African countries have already been disrupted, including prevention, testing, and treatment services. Hundreds of thousands of people who once had free access to crucial antiretroviral treatment (ART) have been cut off.
Shortly after the aid cut announcements, the US secretary of state issued an emergency waiver to resume “life-saving” humanitarian assistance, including HIV treatment but not prevention programmes – unless they are for pregnant or breastfeeding women, presumably, to stop transmission from mother to child. Projects related to “gender ideology” or diversity, transgender surgeries or family planning are forbidden under the waivers.
According to the Global HIV Prevention Coalition, the US was responsible for two-thirds of international financing in developing countries.
PEPFAR funds made up about 17% of South Africa’s HIV budget ($400 million), ensuring that about 5.5 million people received antiretroviral (ARV) treatment yearly.
Similarly, more than half of HIV medicines bought for the Democratic Republic of Congo (DRC), Mozambique, Tanzania, and Zambia are secured through US funding, according to the UN.
Of the 20 countries that are most reliant on US aid for HIV/AIDs programmes, 17 are in Africa. They include: DRC, Mozambique, Tanzania, Zambia, Uganda, Nigeria, Rwanda, Angola, Kenya, Ukraine, Burkina Faso, Burundi, Zimbabwe, Togo, Côte d’Ivoire, Eswatini, and Benin. The other three are Haiti, El Salvador and Nepal.
A Devastating Blow to Progress Against HIV/AIDS
Pepfar, launched in 2003, is credited with saving 26 million lives, according to UNAIDS. The program’s spending totals approximately $120 billion since its inception.
South Africa has made significant progress in expanding access to HIV treatment, resulting in a 66% decrease in AIDS-related deaths since 2010. New HIV infections have also fallen by 58%, according to UNAIDS.
The US decision to halt funding to UNAIDS, the UN’s HIV/AIDS programme, will likely compound the resource challenges faced by nonprofits trying to serve patients and vulnerable communities.
The aid cuts and the restrictions placed on the types of projects that can receive funding will have a devastating impact on the fight against HIV/AIDS in Africa, reversing years of progress and condemning millions to preventable suffering and death.
Which HIV programmes have been cut in Africa?
- South Africa: Several HIV treatment clinics have been shut, including in rural areas of KwaZulu-Natal, which has about 1.9 million people living with HIV and is the worst-affected region in the country. That has caused an influx of patients to other overstretched general public facilities, according to reports by The Associated Press agency. Facilities such as Engage Men’s Health in Johannesburg, which supported gay men, or the Tswane HIV/tuberculosis clinic in Pretoria have been closed. In total, about 222,000 people living with HIV, including 7,445 children under the age of 15, face disruptions in their daily antiretroviral therapy supplies, according to UNAIDS.
- In Ivory Coast, where the US supported more than 400,000 adults and children living with AIDS, 516 health facilities have been completely shut down, according to the UN. Eighty-five percent of people on HIV treatment are affected, and more than 8,600 staff, including doctors, nurses, and midwives affected.
- An orphanage in rural Botswana, catering to children living with HIV, has been shut down, according to reporting by The New York Times.
- In Mozambique, the UN says HIV testing is no longer available in most parts of the country, and community workers, educators, and counsellors who worked with PEPFAR-funded projects have stopped receiving payments.
- In Tanzania, community health workers, educators, and counsellors funded by PEPFAR have lost their jobs.
- An HIV vaccine trial led by BRILLIANT Consortium, a medical research organisation in South Africa, and with $45m in funding support from USAID, has been paused, according to Stat News. The trial aimed to produce neutralising antibodies that could potentially fight off HIV. It was supposed to launch in late January, with 48 participants across three countries: Uganda, Kenya and South Africa.
