PEPFAR Cuts Endanger AIDS Workers in Africa

When U.S. foreign aid shifted under the Trump administration, AIDS workers across Africa felt the impact immediately. PEPFAR funding cuts are now endangering vulnerable populations in South Africa and Mozambique, threatening decades of hard-won progress in the global fight against HIV/AIDS, according to a series of reports by NPR.

Context: PEPFAR’s Legacy Under Threat

President George W. Bush launched the President’s Emergency Plan for AIDS Relief (PEPFAR) in January 2003, creating what is widely regarded as the most successful global health initiative ever undertaken by a single nation. The State Department estimates the program has saved roughly 26 million lives. For over two decades, PEPFAR enjoyed broad bipartisan support, funding antiretroviral medicine for 20.6 million people globally by September 2025.

But the Trump administration has radically restructured U.S. foreign assistance. On January 28, 2025, the Hillbrow Clinic in Johannesburg — a U.S.-funded facility serving approximately 15,000 people annually — closed its doors. By February 26, 2025, 90% of global projects administered by USAID under PEPFAR were terminated. Over 8,000 people lost their jobs, and funding to 70% of healthcare facilities stopped, as reported by the Cape Times.

South Africa: Community Health Workers Struggle to Cope

In Soweto Township, Johannesburg, the organization We Care once employed more than 30 community health workers. After losing PEPFAR funding, only four remain on month-to-month contracts, some with reduced pay. These workers — Marisa Mutswelitsani, Ayanda Adams, Dora Dikota, and Mamohato Mokosi — now serve the same communities with a fraction of the resources, as documented by NPR.

“When the program was there, at least the number of new infections were decreasing,” Mokosi told NPR. “So now that we don’t have funding, the number is going up.” The remaining workers are overstretched, visiting four to nine more houses each, and struggling to maintain the trust they once built with patients.

South Africa has the highest number of people living with HIV of any country. While the nation had reduced its dependence on U.S. funding to about 17% of its HIV budget, that American funding often went to specialized programs for the most at-risk populations.

Sex Workers Left Without Critical Care

The closure of the Hillbrow Clinic, operated by the Wits Reproductive Health and HIV Institute, has been devastating for sex workers in Johannesburg. An estimated 60% of sex workers in South Africa have HIV, and sex work is illegal, making access to stigma-free care essential.

Thalita Maleka, a peer educator with the nonprofit Sisonke — which has seen its staff shrink from 34 to nine — described the impact. “They closed because of the American guy,” she told NPR, referring to President Trump. “I remember when we all received the news, it was very devastating.”

Patients like Yvonne, a 39-year-old sex worker, now travel more than an hour by taxi to reach a different clinic. Others, like Detris M’banjua who is HIV-positive, have missed appointments and run out of medication. The peer educators sometimes use their own money to help.

Mozambique: DREAMS Deferred

In Mozambique, which has the second-largest AIDS epidemic globally, the DREAMS program — a PEPFAR initiative focused on HIV prevention for adolescent girls and young women — was terminated. Gaza Province, the hardest-hit area, was at the center of the program’s work.

Arminda Nafungo, who runs the organization ACTIVA, described the abrupt end as “so scary” in an interview with NPR. Former DREAMS mentor Jose Bento shared a heartbreaking story: a 13-year-old girl named Leticia, whom he had helped recover from HIV, died after becoming pregnant when his visits stopped due to funding cuts.

“This isn’t just a funding cut. It’s people’s lives,” Bento said.

The Human and Economic Toll

A study published by STAT News in March 2025 projected that eliminating PEPFAR could lead to 601,000 HIV-related deaths and 565,000 new infections in South Africa alone over 10 years. The study was co-authored by Anne Neilan of Harvard Medical School and Linda-Gail Bekker of the Desmond Tutu HIV Foundation.

What’s Next

In a significant development, South Africa launched the lenacapavir HIV prevention drug on June 5, 2026, without U.S. support, relying instead on the Global Fund and generic licensing agreements, as reported by the Eastern Herald. The twice-yearly injection could be transformative, but experts warn that the community outreach infrastructure needed to deliver it has been severely weakened by the cuts.

Meanwhile, diplomatic relations between the U.S. and South Africa remain at a low point, with no direct aid agreement in place. As Thalita Maleka, the peer educator in Johannesburg, put it: “If we want to end HIV and AIDS, then I believe that the whole world needs to come up together and help one another.”

For the AIDS workers still showing up — often without pay, using their own money to buy bread for patients’ families — the work continues, regardless of decisions made in Washington.