HIV/AIDS support is latest casualty in Trump's 'white genocide' beef

The Trump administration is winding down America’s HIV/AIDS prevention and treatment services in South Africa, with the termination of most of the program expected to be completed by September, though critical support is scheduled to continue through next March.

The decision to end the country’s access to the “PEPFAR” program is controversial. According to an anonymous State Department official, the administration chose to cut funding to South Africa as a response to its alleged failure to protect its white Afrikaner population from what President Donald Trump has called, without providing evidence, a “genocide.”

PEPFAR — which provides support for the prevention and care of those afflicted with HIV/AIDS around the world — is considered one of the most successful U.S.-sponsored humanitarian relief efforts in history. Launched under President George W. Bush in 2003, PEPFAR is responsible for saving the lives of an estimated 26 million people around the world.

This isn’t the first time Trump has cut aid to South Africa. Just weeks after the start of his second term in January 2025, he signed an executive order suspending much of the U.S. humanitarian and development aid to the country, ostensibly due to the South African government’s failure to protect its white population. Controversially, the order also provided refugee status for white Afrikaners claiming to flee violence — a direct contrast to Trump’s broader policy of drastically reducing the number of immigrants and refugees permitted to enter the United States.

Though only one part of South Africa’s HIV/AIDS funding stream, PEPFAR has been a major contributor to preventive care and emergency response efforts to the infectious disease in the country. Around 17% of South Africa’s annual HIV budget came from PEPFAR, accounting for around $400 million a year. Since the program’s launch, South Africa has received nearly $8 billion in PEPFAR support.

The human toll stemming from the end of PEPFAR in South Africa is likely to be substantial. According to the World Health Organization, the country has more HIV-positive individuals than any other in the world — 7.8 million cases, nearly 13% of the country’s population.

One study published by health researchers last year estimates that the complete termination of PEPFAR in South Africa would lead to between 1.1 to 2.1 million new HIV infections over the next two decades, and the deaths of between 519,000 to 712,000 people over that same period.

These cuts come at a critical moment for South Africa in its fight against the infectious disease which has been responsible for the deaths of about 4.3 million South Africans since its first reported case in 1982.

South Africa recently began rolling out a new HIV drug called lenacapavir, which is injected biannually into the stomach of high-risk individuals, significantly reducing the likelihood that they will contract the disease. But with reduced American financial support, access to the drug — which costs about $28,000 per person per year — will be severely limited until a generic version costing about $40 per person becomes available next year.

Without continued PEPFAR support, however, questions abound over how funding shortages might increase the challenges of ensuring South Africans can access the drug, even after the per-year cost is reduced. Research shows that PEPFAR cuts in South Africa have already reduced community-based health services such as HIV testing as well as access to preventive medications — of which lenacapavir is the latest one — for people across South Africa. This is partially due to the fact that extended wait times and overburdened staff make it harder for those in need of medical services to receive them.

And the Trump administration has already reduced the new drug’s reach across the country, with South Africa reportedly having been excluded from a State Department plan to supply up to 2 million doses of lenacapavir across several high-demand countries.

Cutting U.S. foreign aid has been a central component of Trump’s “America First” foreign policy in his second term. This includes the sudden and chaotic elimination last year of the U.S. Agency for International Development (USAID), which left contractors, employees, and aid recipients across the world scrambling to figure out how to move forward with sharply reduced or even eliminated levels of American-funded aid.

Until then, the United States was by far the largest single contributor to global health programs in poor countries. In 2024 — the last year before Trump took office — the U.S. government contributed over $12 billion for global health work, about 45% of which was dedicated to HIV. Trump’s fiscal year 2027 budget request seeks to cut $4.3 billion from the US government’s global health spending, citing waste and the promotion of unnecessary programs, such as funding for abortions and birth control.

In the months since, the administration has tried to shift its global development efforts away from traditional grant-making and humanitarian initiatives and toward private-sector investment. It has used the Development Finance Corporation (DFC), which provides financial assistance and other support to private companies looking to invest in high-risk places where profitability is hard to achieve.

There is, of course, value in using the DFC and similar organizations, such as the U.S. Export-Import Bank, to promote sustainable economic growth and infrastructure development across the world. But such finance-focused, profit-oriented institutions can’t replace the more humanitarian-centered elements of traditional American foreign aid. And with European countries also cutting their own foreign aid commitments in recent years, states across the Global South that have relied heavily on Western governments for life-saving humanitarian and medical support through the years are now finding themselves with fewer resources with which to protect their citizens.

There is little chance that Trump’s decision to entirely end American PEPFAR support for South Africa will benefit American interests. Trump’s cuts to medical and other aid programs serve as a cruel reminder to Global South states around the world of the dangers of over-reliance on aid from a United States led by a transactional president willing to use critical forms of support as a bargaining chip.

As a result, this will likely increase the speed with which countries across the world seek to diversify global partnerships away from the United States, to countries more likely to provide reliable streams of support.

And the fact that Trump is tying foreign aid to South Africa to an issue that has no evidentiary basis — that a “genocide” against white Afrikaners is actually taking place — serves only to make him appear even less reliable as a partner, and increases Pretoria’s motivation to forge those alternate partnerships.

The fewer close partners the U.S. has across the Global South, the more isolated it becomes in parts of the world that contain large populations, critical resources, and potentially relevant security challenges that affect U.S. interests.