The head of the FW de Klerk Foundation has urged US President Donald Trump to reconsider the reported withdrawal of HIV-related funding from South Africa. The debate around SA’s PEPFAR Funding has become increasingly important as it impacts countless lives in the country.
Foundation chief executive Christo van Rheede made the appeal in a letter to Trump. He called on Washington to separate its diplomatic disagreements with the South African government from assistance for vulnerable communities.
Van Rheede warned that removing infrastructure supported by the President’s Emergency Plan for AIDS Relief could disrupt essential health programmes. The initiative is widely known as PEPFAR.
He said geopolitical tensions should not catch millions of people in the crossfire.
Van Rheede argued that continued engagement would provide a better path forward. It could encourage South Africa to grow its economy, strengthen the rule of law and address challenges affecting the wider population.
South Africa PEPFAR Funding Under Threat
The Trump administration has reportedly decided to end PEPFAR support for South Africa. The move reportedly follows concerns that Pretoria has failed to meet several US policy demands.
Semafor reported that these demands included changes to South Africa’s black economic empowerment policies. They also reportedly included reduced ties with Iran and action over the anti-apartheid song “Kill the Boer”.
The proposed withdrawal has not yet been formally communicated to the South African government.
Department of Health spokesperson Foster Mohale said the department expected the development. Health Minister Aaron Motsoaledi and US Ambassador Leo Brent Bozell III will provide more details after their upcoming meeting.
The meeting was due to take place last week. However, it was postponed, and a new date has not been announced.
South Africa PEPFAR Funding And Medicine Supplies
The Department of Health has reassured patients that the reported decision will not affect antiretroviral medicine supplies.
PEPFAR does not directly finance the HIV treatment medicines distributed through South Africa’s public health system.
The government provides around 90% of the funding for HIV treatment at state health facilities. The remaining share comes from the Global Fund to Fight AIDS, Tuberculosis and Malaria.
However, PEPFAR has supported many other parts of the country’s HIV response. These include prevention services, patient monitoring, health infrastructure and community-based care programmes.
The US initiative has provided more than $8 billion to South Africa over the past two decades. Its withdrawal could therefore create serious operational gaps, even when medicine supplies remain protected.
Health Department Prepares For Reduced US Support
South Africa has been preparing for a reduction in American health funding since Trump cancelled grants distributed through the US Agency for International Development in February 2025.
The Health Department said it had been developing a plan to limit the impact on services and communities.
Following his inauguration for a second term, Trump moved to reshape US foreign assistance under an “America First” strategy. His administration reduced international health spending, withdrew the US from the World Health Organisation and dismantled USAID.
USAID previously distributed around half of the PEPFAR funding to countries with high HIV burdens. The remaining funds were channelled through the US Centers for Disease Control and Prevention.
Washington later began negotiating bilateral health agreements with countries that had received American assistance. More than 30 agreements had reportedly been signed by early June. Most involved African countries.
South Africa’s current uncertainty highlights a broader danger: diplomatic and economic disputes can quickly jeopardise long-term public health programmes.
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