UNAIDS chief urges U.S. to reverse South Africa HIV aid cuts

South Africa’s HIV response sits on a fragile financial edge: U.S. aid has covered as much as 17% of the country’s HIV funding and helped pay the salaries of roughly 15,000 health workers. Winnie Byanyima, the head of UNAIDS, warned that pulling that support back could hit treatment access, prevention programs and the people most at risk in the country with the world’s largest HIV population.

Speaking at a U.N. briefing before a high-level HIV/AIDS conference, Byanyima urged Washington to reverse the decision and said she was deeply concerned by the move. Asked about the American pullback, she added, “I’m sad about that.”

The Trump administration has begun a phased drawdown of PEPFAR support in South Africa after the State Department said Pretoria had failed to make demonstrable progress on policy requests from Washington. The department told Semafor that it planned to close out PEPFAR in South Africa by early next year, arguing that the program was never meant to be permanent and that South Africa, as a middle-income country, should be able to fund its own health programs.

The scale of what is at stake is stark. South Africa’s government estimated that about 8.0 million people were living with HIV in 2024, equal to 12.7% of the population. UNAIDS said 6.3 million people were accessing antiretroviral therapy at the end of December 2024, but that still left a gap against the 7.8 million who needed treatment. UNAIDS also said about 332,690 people did not know they were living with HIV in 2024, a blind spot that complicates testing and prevention.

The United States has invested more than $100 billion globally through PEPFAR, the largest commitment by any nation to a single disease. In South Africa alone, the annual contribution has been more than $400 million, with one estimate putting the 2024 total at about $423 million. Earlier PEPFAR cuts already rattled the system: UNAIDS said about 8,493 PEPFAR-funded staff were affected by termination letters in February 2025.

The funding fight has also become entangled in broader political friction. Reporting linked the decision to South Africa’s posture on Iran, its Black Economic Empowerment policies and chants such as “Kill the Boer.” Politico reported that the State Department also tied the move to concerns about the treatment of South Africa’s white citizens.

South African officials have warned that earlier cuts were a “train smash” for workers, while Parliament’s health committee said the shock should push the country to reduce dependence on foreign money and strengthen health sovereignty. But with millions still dependent on antiretroviral therapy, any rapid retreat from PEPFAR risks unsettling one of the world’s most consequential public health systems.