The Trump administration has abruptly terminated contracts for approximately 10,000 projects funded by the US Agency for International Development (USAID), affecting critical HIV, malaria, and humanitarian aid programs worldwide. Among the hardest hit are hundreds of African HIV organizations that provide life-saving services, which received immediate termination notices on Thursday morning.
Additionally, the administration announced a halt to US funding for the Joint UN Programme on HIV/AIDS (UNAIDS), sparking outrage and concerns over the devastating consequences for global HIV efforts.
Immediate impact on African HIV programmes
Dr. Kate Rees of South Africa’s Anova Health Institute, which delivers HIV services to marginalized communities, described the decision as catastrophic.
“This is one of the worst days of my professional life,” she said. “Tomorrow, we are letting go of 2,800 people—mainly peer educators and data capturers.”
Prof. Linda-Gail Bekker, CEO of the Desmond Tutu HIV Foundation, warned that the funding cuts could lead to 500,000 deaths in South Africa over the next decade and an equal number of new HIV infections, based on recent projections.
“As an activist and someone living openly with HIV, I am deeply hurt,” said Sibongile Tshabalala, chairperson of the Treatment Action Campaign. “Will the public healthcare system be able to fill this gap, given its existing challenges?”
South Africa, which has the highest HIV burden globally—affecting over eight million people (more than 16% of the adult population)—will be severely impacted. All 44 South African HIV programs funded through the US President’s Emergency Plan for AIDS Relief (PEPFAR) via USAID have been cut, including mother-to-child transmission prevention programs, hospices, research groups, and initiatives supporting key populations vulnerable to HIV.
Kholi Buthelezi, national coordinator of the sex worker organization Sisonke, expressed grave concerns.
“I’ve had sleepless nights wondering how to protect our communities. Many government health facilities remain deeply discriminatory,” she said.
Regional devastation and global repercussions
The impact extends beyond South Africa. The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) was instructed to shut down programs in Lesotho, Eswatini, and Tanzania, affecting HIV treatment for 350,000 individuals, including nearly 10,000 children.
In Uganda, the Baylor College of Medicine Children’s Foundation’s HIV and TB programs, which strengthen district health systems, were also terminated.
Termination letters cited a decision by US Secretary of State Marco Rubio, acting as USAID administrator, and Peter Marocco, acting deputy administrator, stating that these programs “are not aligned with agency priorities” and that their continuation “is not in the national interest.”
‘Chaos and disaster’
South African public health leaders decried the move as an unprecedented crisis.
“This is chaos. This is disaster,” said Fatima Hassan, head of the Health Justice Initiative, urging the South African government to issue compulsory licenses to reduce antiretroviral drug prices.
“US Congress approved these funds, yet they’ve been illegally halted. This decision does not follow due process,” she added.
Dr. Lynne Wilkinson, a public health expert, emphasized that the termination of USAID funds will cripple South Africa’s HIV testing, data collection, TB literacy, and gender-based violence prevention efforts.
Although South Africa derives only 17% of its HIV budget from PEPFAR, other African nations are more dependent. The Democratic Republic of Congo (DRC) relies on PEPFAR for 89% of its HIV funding, while Mozambique and Tanzania each receive 60% of their HIV budgets from US support.
Legal battle against blanket terminations
Mitchell Warren, head of the US-based HIV advocacy organization AVAC, described the sweeping termination of USAID grants as unlawful.
“The US government has significant discretion in amending or canceling grants, but a blanket freeze is illegal,” Warren said, adding that AVAC has taken legal action to challenge the cuts.
A federal court recently issued a temporary restraining order requiring USAID to reinstate funding until a 90-day review is conducted. However, the Trump administration has introduced legal delays to stall the process.
A federal judge had set a Wednesday midnight deadline for USAID to release $1.5 billion in previously approved aid, but the US Supreme Court granted a stay, delaying the funds’ release pending further review.
“We expect a hearing next week in Washington,” Warren said. “This is not just about PEPFAR or USAID—it’s about the rule of law. Congress controls the purse strings, and the executive branch is supposed to execute its decisions. What we’re witnessing is a massacre of life-saving programs. This court case, as critical as it is, won’t reverse the damage overnight. That’s why collaboration with national governments and other stakeholders is now more essential than ever—because right now, the United States is not a trustworthy partner.”
HealthPolicyWatch
