Johannesburg – Overnight, the landscape of South Africa's battle against HIV/Aids was irrevocably altered. Organisations reliant on funding from the President's Emergency Plan for Aids Relief (Pepfar), channelled through the United States Agency for International Development (USAID), awoke to the devastating news: their grants had been terminated, effective immediately.
The move, orchestrated by the Trump administration, has ignited a firestorm of condemnation from health experts, activists, and civil society, who warn of catastrophic consequences for vulnerable populations and the potential unraveling of years of hard-won gains.
The Anova Health Institute, a leading recipient of Pepfar funding in South Africa, has been particularly hard hit, losing all its funding. A senior official confirmed to Bhekisisa that Anova played a crucial role in HIV testing and treatment provision in understaffed government clinics. The impact is widespread, affecting not only HIV programmes but also TB programmes funded through USAID, which have also received termination letters.
The Accelerating Programme Achievements to Control the Epidemic (Apace), a collaborative effort involving prominent non-profits such as the Wits Reproductive Health Institute, Broadreach Healthcare, and Right to Care, has also been targeted. Apace projects have been vital in HIV testing, treatment initiation for those testing positive, preventive anti-HIV pill distribution for high-risk individuals, increased access to HIV treatment for children, and TB testing and treatment for people with HIV.
While the full extent of the funding cuts remains unclear, Bhekisisa has confirmed that projects focusing on key populations, including LGBTQI+ groups, and those working with orphans and vulnerable children, have been instructed to cease operations immediately. Reports from Pepfar-funded projects in Kenya and Malawi suggest that similar termination letters have been issued in those countries, raising concerns about a broader regional impact.
Adding insult to injury, some organisations received emails with attached letters signed off with the chillingly ironic phrase, "thank you for partnering with USAID and God Bless America."
The termination letters themselves offer a glimpse into the rationale behind the drastic measures:
"Dear Implementing Partner,
This award is being terminated for convenience and the interests of the U.S. Government pursuant to a directive from U.S. Secretary of State Marco Rubio, in his capacity as the Acting Administrator for the U.S. Agency for International Development ("the Agency" or "USAID") and/or Peter W. Marocco, who is performing the duties and functions of both Deputy Administrators for USAID.
Secretary Rubio and PTDO Deputy Administrator Marocco have determined your award is not aligned with Agency priorities and made a determination that continuing this program is not in the national interest. The decision to terminate this individual award is a policy determination vested in the Acting Administrator and the person performing the duties and functions of the Deputy Administrator.
I have been delegated authority to issue this termination notice.
Detailed instructions will follow, and a formal modification/amendment to memorialize this action is forthcoming. Immediately cease all activities, terminate all subawards and contracts, and avoid incurring any additional obligations chargeable to the award beyond those unavoidable costs associated with this Termination Notice. Immediately provide similar instructions to all subrecipients and contractors.
Kindly confirm receipt of this Termination Notice via electronic email response to the sender."
While Pepfar projects receiving funds through the Centres for Disease Control and Prevention (CDC) are still operational, many report having only enough funding to operate until the end of March.
A Chorus of Condemnation: South African Health Experts Respond
The sudden cuts have been met with widespread condemnation from health experts and activists in South Africa, who accuse the Trump administration of jeopardising the lives of millions and undermining decades of progress in the fight against HIV/Aids. A common thread in their responses is a call for the South African government to step up and provide leadership in the face of this crisis.
Yvette Raphael, co-founder and co-director of Advocacy for Prevention of HIV and Aids (APHA), minced no words: "We are deeply concerned about the bad decision to end USAID. The Trump administration has declared war on the right to health globally. The South African government must take this as an opportunity to expedite universal access to healthcare and meet its obligations to our people."
Sibongile Tshabalala, chairperson of the Treatment Action Campaign, echoed this sentiment, stating: "The NGO sector in South Africa woke to a letter from USAID terminating grants. It is so painful that these terminations mean death to poor people of the world. Key and vulnerable populations are the most affected. These terminations happen at a time when the whole world is bewildered by these outrageous decisions by the Trump administration.
Linda-Gail Bekker, CEO of the Desmond Tutu Health Foundation, expressed her dismay succinctly: "Saving dollars and spending lives – no words! We now really need to hear the plans from our country health departments how the chaos will be filled urgently."
An HIV clinician, speaking anonymously, who has worked with the health department for 17 years, issued a stark warning: "Government has to cease the inaction and their seeming return to the behaviour we saw during the worst years of Aids denialism, where politicians let their own opinions impact hundreds of thousands of lives. This cannot be allowed to happen again.
"Eight million South Africans rely on the government's antiretroviral HIV treatment programme and although Pepfar-funded organisations may only account [along with the health department's Pepfar funds] for 17% of the budget, what they do with that 17% is so critical. Without it, and without an urgent plan to fill the gap, there is no doubt deaths will increase, people will suffer, babies will get infected and die and the monitoring of the programme and its ability to improve and react will become utterly non-existent. The SA government must now also be held to account to step in as we have seen with Nigeria and other African countries."
Fatima Hassan, founder of the Health Justice Initiative, criticised the government's lack of urgency and communication: "One expects a greater sense of urgency and better communication from the health ministry and other departments including the presidency in this time of crisis. They are downplaying the financial and human impact in South Africa, and that will not take us forward.
"As civil society we wrote in early February to the government, asking for its urgent plan, we got no response. We wrote again, and a month later we still await its urgent plan, which shockingly, we learnt from media reports that an assessment is being outsourced to Deloitte and will take a month or longer while right now there is a crisis! We spent decades fighting and litigating for the human right to receive proper healthcare services for HIV especially. This is all going up in smoke because of the impact of the Trump administration’s ideological executive orders and actions and its own defiance of court orders in the US — and because our government has no urgent plan to absorb staff, programmes, patients and communities. The impact is there for all to see — and frankly, one circular from the national health department which is not even being fully implemented, will not mitigate the chaos. Government should answer — where is the money and where is the plan?"
Kholi Buthelezi, director of Sisonke, highlighted the devastating impact on vulnerable populations: "Sex workers are at increased risk for a range of health issues, including sexually transmitted infections (STIs), TB, HIV, and violence-related injuries. In South Africa, access to regular health screenings, education, and preventive care should be a basic right, not a privilege. When a major funding partner like USAID pulls its support, the ripple effects are felt throughout the entire ecosystem of services designed to support these individuals. This is why the government must step up now."
An anonymous HIV prevention programme implementer in Gauteng painted a grim picture of the consequences: "Cutting USAID funding for health and education programmes in South Africa isn't just about budgets – it's about people. It's about sex workers who no longer have a safe place to get HIV prevention services, LGBTI+ communities losing the support they fought so hard for and thousands now facing a future without the healthcare and education they rely on to survive.
"These aren't just numbers on a spreadsheet. They are lives, futures, and communities being abandoned. The reality is heart breaking: People will suffer, people will die, and decades of progress will be undone. This is not just a funding cut – it's a betrayal of the very people these programmes were meant to protect. And yet, from the national health department, there is silence. No communication, no coordination, no urgency – just a deafening void where leadership should be. The very institutions meant to protect the most vulnerable have offered no plan, no reassurance, no voice. How long must communities wait in fear? How many clinics must close before those in power acknowledge the crisis? This silence is complicity, and it is costing lives."
Kate Rees, a public health specialist, described the immediate impact on healthcare workers and patients: "Our programmes have been officially terminated. Thousands of dedicated healthcare workers across South Africa have been retrenched. I am especially concerned for the community health workers and data capturers, who are financially vulnerable and won't be easily absorbed into the health system. Despite their years of commitment, these healthcare workers have been abandoned with almost no notice. For patients and communities, critical services have already been impacted – including following up on positive HIV tests for babies, following up on possible meningitis cases, and caring for the most vulnerable pregnant women whose babies are now at risk of contracting HIV."
Another public health specialist, speaking anonymously, expressed the sheer devastation felt by those working in the field: "This is absolutely shattering, heartbreaking, and incomprehensible. The termination letters issued by the US state department in the last 24 hours mark the abrupt and devastating end to years – decades – of investment in lifesaving programmes that have transformed communities, saved countless lives, and built essential infrastructure for health, education, and development.
"The intellectual capital, expertise, and dedication poured into these programmes have simply been erased by bureaucratic decisions made overnight. How do you quantify the loss of a child's access to malaria treatment? A mother's TB medication? A community's clean water project? The people – the patients, the frontline workers, the programme recipients who relied on these services for survival – are now left stranded, abandoned by a system that once promised progress and partnership. Every contract cancelled is not just a number; it represents a life, a community, a future now in jeopardy. The sheer disregard for the impact on millions of vulnerable people is unfathomable, and the ripple effects of these decisions will be felt for generations to come."
The sudden withdrawal of USAID funding has thrown South Africa's HIV/Aids response into turmoil. The immediate consequences include programme closures, job losses, and disruptions in essential services for vulnerable populations. The long-term effects could be even more devastating, potentially reversing years of progress in reducing HIV infections, improving treatment access, and preventing Aids-related deaths.
The South African government now faces a critical challenge: to develop and implement an urgent plan to mitigate the impact of the funding cuts and ensure that the country's HIV/Aids response remains on track. The lives of millions of South Africans depend on it.
