The recent decision by the Trump administration, supported by JD Vance and Elon Musk’s Department of Government Efficiency (DOGE), has highlighted Africa’s heavy reliance on foreign aid. This dependence has now been exposed as a tool for control, leaving many countries vulnerable. The sudden termination of funding for health programmes, particularly for HIV and AIDS, has caused widespread concern. Many organisations that have relied on this support for years are now struggling, with some forced to close. Experts warn that without urgent action, the impact could be devastating.
The United States has permanently ended its HIV programme funding, affecting services across Africa. In South Africa alone, this could lead to more than 500,000 deaths over the next decade, with millions more affected across the continent. African governments were caught off guard by this decision, showing a lack of preparation for such an event. Without alternative funding in place, healthcare systems are now at risk. Beyond the impact on patients, thousands of healthcare workers are losing their jobs, further weakening essential services.
Termination notices have been sent to organisations in Malawi, Zambia, Tanzania, Zimbabwe, and UNAIDS, the United Nations’ programme on HIV/AIDS. Countries like Malawi, which depend heavily on aid, will be hit hard, and South Africa is already struggling to cope.
The Elizabeth Glaser Paediatric AIDS Foundation has lost funding for three key projects, which provide treatment for over 350,000 people in Lesotho, Eswatini, and Tanzania. Among them are more than 10,000 HIV-positive pregnant women who need continuous treatment to prevent passing the virus to their babies. Dr Lynne Mofenson, a senior adviser at the foundation, called this decision “a death sentence for mothers and children.”
The funding cuts mostly affect the President’s Emergency Plan for AIDS Relief (PEPFAR), which was launched in 2003 by George W. Bush. In South Africa, PEPFAR funds 17% of the country’s HIV response, with even higher dependency in other countries.
Professor Linda-Gail Bekker, director of the Desmond Tutu HIV Centre at the University of Cape Town, has warned of a looming disaster. Her research suggests that without PEPFAR funding, South Africa could see an additional 500,000 HIV-related deaths in the next decade. This is happening at a time when medical advances, such as long-acting injectable treatments, had given hope of controlling the disease.
The cuts also threaten vital HIV research, including vaccine trials and new prevention methods. US funding had supported clinics for vulnerable groups, such as transgender people and sex workers, ensuring they could access healthcare without fear of stigma.
Kholi Buthelezi, national coordinator of Sisonke, a sex workers’ organisation, described the situation as deeply worrying. “I’ve been having sleepless nights. This reminds us of the days when there was no treatment for HIV,” she said. At a recent press briefing, she and other HIV advocates in South Africa urged the government to step in and fill the gap left by the US.
Some programmes funded by the US Centres for Disease Control and Prevention (CDC) are still running, but their future remains uncertain. Dr Kate Rees, a public health expert at the Anova Health Institute, said there had been plans to shift donor-funded programmes to government funding over the next five years. However, with the sudden loss of US support, this transition has turned into a crisis. “Instead of a careful handover, we’re being pushed off a cliff,” she said.
The impact is already being felt. “Tomorrow, we are letting go of more than 2,800 people,” Rees revealed. “That includes counsellors, data capturers, and healthcare workers people who will struggle to find new jobs.” This crisis is a wake-up call for African governments. It shows the dangers of relying on foreign aid for essential healthcare. Unless leaders take urgent action to build strong, self-sufficient health systems, the continent will remain vulnerable to external decisions beyond its control.
Now is the time for Africa to invest in its own future. Millions of lives depend on it.
