The United States has signed a $5.88-billion spending package into law to support the global response to hiv, one year after cuts to Pepfar funding disrupted programmes in South Africa and elsewhere. Experts in South Africa see indirect benefits through international agencies but express concerns over ongoing gaps in local services. The funding aims to reinforce Us leadership in hiv efforts amid volatile aid commitments.
Exactly one year ago, the United States Agency for International Development (USAID) terminated Pepfar funding for hiv organisations in South Africa, following President Donald Trump's executive order for a 90-day freeze on foreign development assistance. This led to the collapse of key services worldwide, including in South Africa.
On 3 February 2026, Trump signed a bipartisan $5.88-billion package into law. It allocates $4.6 billion for bilateral hiv support under the America First Global Health Strategy, $1.25 billion to the Global Fund to Fight Aids, Tuberculosis and Malaria, and $45 million to UNAids. UNAids described it as reinforcing Us commitment to the global hiv response.
Dr Kate Rees from the Anova Health Institute noted that funding to the Global Fund benefits South Africa indirectly, as the country participates in this global ecosystem. Anova, which lost its Pepfar funding, continues hiv programmes for key populations with Global Fund support. However, Rees said direct Us funding to South African programmes is unlikely.
Professor Francois Venter from Wits University agreed there would be some benefit through technical support but emphasised the need for a more agile South African government response. He described the hiv sector one year post-cuts as "every bit as grim as we predicted," with key population programmes nearly destroyed and no evidence of services relocating.
Professor Linda-Gail Bekker, CEO of the Desmond Tutu Health Foundation, raised concerns about reduced testing, antiretroviral access and viral load monitoring due to lost data collection mechanisms from foreign aid. In October 2025, South Africa received a $115-million Pepfar Bridge Plan via the Centres for Disease Control and Prevention, set to end on 31 March 2026, with no extension confirmed.
Bekker noted the sector has accepted doing more with less, while Rees highlighted that hiv prevention has taken a back seat and called for prioritising the roll-out of Lenacapavir, a new long-acting antiretroviral, alongside robust budgeting. Venter urged redesigning the programme without relying on past Us models to protect gains amid reduced resources.