US President Donald Trump’s shock executive order to halt foreign aid to SA does not apply to the President’s Emergency Plan for Aids Relief (Pepfar), the US embassy has confirmed.
Pepfar is the single biggest foreign donor to SA’s HIV/Aids programmes, and has contributed more than R140bn to SA in the past 20 years in recognition of its HIV/Aids burden.
SA is home to the world’s biggest HIV/Aids population, with an estimated 7.8-million people living with the disease. The US contributed 17% of the country’s R44.4bn HIV/Aids budget in 2023/24, according to government figures.
The work of Pepfar-supported organisations in more than 50 countries was brought to a grinding halt by an executive order signed by Trump within hours of his inauguration on January 20 that froze all foreign aid for 90 days, pending a review to check it aligned with his foreign policy agenda.
A waiver for “life-saving and humanitarian” aid subsequently signed by US secretary of state Marco Rubio opened the way for some Pepfar-supported activities to potentially resume, but Trump’s executive order against SA on Friday cast fresh doubt on the programmes future in SA.
The US embassy said that Pepfar was still covered under the waiver granted by Rubio.
“Pepfar’s implementing agencies are reviewing which activities fall under the limited waiver. It is important to note that not all Pepfar activities will resume,” a US embassy official said. The waiver excludes abortions, family planning, gender or diversity programmes and transgender surgeries.
“Each agency is following its own process for resuming activities as required by federal law. Our teams are working as fast as we can to prepare the administrative documentation needed to resume activities covered under the limited waiver,” the embassy official said.
Pepfar works with four US government agencies: the US Agency for International Development (USAID), the Centres for Disease Control and Prevention (CDC), the Peace Corps and state department.
By Monday evening, Pepfar’s implementing partners in SA had begun to receive letters from USAID and CDC with instructions about how to apply to resume their activities.
Sources who spoke to Business Day on condition of anonymity said implementing partners had been asked to confirm they would not provide services prohibited under the waiver.
They have been asked to submit revised budgets for review and await further instruction. It was not clear when they would be able to draw down funds to cover salaries and operational costs, or when they could resume their activities, they said.
“The waivers are welcome, but tremendous harm has been done. You can’t restart these complex programmes overnight. Many programmes have not received waivers and it is unclear how long waivers are for. We have made such inroads against HIV, this will surely see a rebound in infections and hospitalisations,” Francois Venter, an HIV clinician at Wits University said.
A global coalition of health activists called on President Cyril Ramaphosa to personally intervene to fix the crisis, which they said was devastating for stigmatised communities excluded from the waiver.
Thousands of sex workers, transgender people and drug users who previously relied on the services provided by Pepfar-funded organisations have been left in the lurch, said the Community Health & HIV Advocates Navigating Global Emergencies (Change).
An estimated 9,000 people had lost access to needle exchanges and opioid substitution in Mpumalanga, Limpopo and Gauteng, it said, noting that most public clinics do not offer these services.
“The reckless freezing of US foreign aid is nothing short of a death sentence for thousands of people in SA. We are watching decades of progress on HIV being decimated,” Treatment Action Campaign chair Sibongile Tshabalala said.
Health Justice Initiative founder Fatima Hassan said the government needed to provide an unambiguous commitment to step into the breach. The government could also amend the Patents Act and start preparing to issue compulsory licences to bring down the price of medicines, she said.
Presidential spokesperson Vincent Magwenya referred Business Day to the president’s state of the nation address on Thursday, during which he expressed concern about the potential impact of the US government’s decision to suspend some of its funding for HIV and tuberculosis programmes.
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