UNAIDS warns Trump's HIV funding cuts to South Africa could cost lives
The Trump administration says the phased withdrawal is linked to policy disputes with Pretoria, which rejects the allegations and says it is pursuing greater self-reliance.
The United States has decided to withdraw all funding for South Africa's HIV and AIDS response through the President's Emergency Plan for AIDS Relief (PEPFAR), a programme that has contributed about $400m (€340m) a year to the country's fight against the disease.
The move comes as relations between Washington and Pretoria continue to deteriorate.
The head of the United Nations HIV agency, Winnie Byanyima, warned that the decision could have serious consequences for public health in South Africa, which has the world's largest HIV-positive population with more than eight million people living with the virus.
Speaking ahead of a UN meeting, she said: "Please do not take money away because you are taking lives away."
Byanyima said the loss of US funding risks undoing years of progress in preventing new infections and supporting vulnerable communities. According to UNAIDS, PEPFAR has been providing around 17% of South Africa's total HIV response funding.
She said: "Taking it away is taking life-saving support from the most vulnerable people."
South Africa does not depend on US funding to buy antiretroviral medicines, as those are financed by the government. However, American support has been crucial for prevention programmes, testing services, community outreach and assistance for groups most at risk of contracting HIV.
The US State Department said the funding withdrawal is part of a "phased drawdown" linked to what it described as South Africa's "failure to make demonstrable progress on policy requests by the administration". US officials have also said the decision was influenced by concerns over the treatment of the country's white Afrikaner minority.
The South African government has rejected those allegations. Pretoria says its Black Economic Empowerment policies are designed to address deep inequalities that persist from the apartheid era. It has also dismissed claims by US President Donald Trump that a "white genocide" is taking place in the country, saying there is no evidence to support the accusation.
South Africa's health ministry said it had not been formally informed of the funding decision but added that it had "long been working on a self-reliance plan". Officials maintain that the country is prepared to assume greater responsibility for financing its HIV response, although experts warn that replacing lost prevention funding will be difficult.
INTERVIEW
'One injection protects up to six months': what is new HIV drug lenacapavir?
As South Africa becomes the ninth African country to introduce the use of new long-acting drug lenacapavir for HIV prevention, RFI spoke with infectious disease specialist Ndong Essomba Bitchoka about how the treatment works, whether the supply will meet demand and why developing an HIV vaccine remains a challenge.
Issued on: 21/06/2026 - RFI
Lenacapavir is administered as an injection twice a year. © AFP - IHSAAN HAFFEJEE
New long-acting antiretroviral treatment lenacapavir requires just two injections a year, reducing the need for daily pills. But questions remain over access, cost and whether enough doses will be available to meet demand in the country with the world's largest HIV-positive population.
Ndong Essomba Bitchoka oversees the HIV/AIDS and tuberculosis care unit at the District Deido hospital in Douala, Cameroon.
RFI: South Africans living with HIV can now benefit from lenacapavir. Can you explain how this new treatment works?
Ndong Essomba Bitchoka: Lenacapavir is an antiretroviral drug. It prevents the assembly of the HIV virus's RNA molecules, which stops new HIV viruses from forming. That is essentially how it works.
[It] can be used to treat HIV infection and help control the virus in certain patients. Instead of taking tablets every day, patients receive injections that limit the virus's replication in the body for around six months.
The patient must first have their condition controlled with oral medicine, meaning tablets. Lenacapavir then supports the action of the antiretroviral drugs already being used to control the virus. The same level of control can then be maintained over a longer period when combined with other medicines.
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RFI: Do you have any idea how much the treatment costs?
NEB: I do not know the exact cost, so I cannot give a precise answer.
In many countries, such as Cameroon where I am from, lenacapavir is not yet available. In many cases, however, governments and financial partners work to subsidise these medicines. So, patients do not have to pay.
But in South Africa, I don't yet know whether that will be the case, but I believe the government is working to see how it can subsidise access to these antiretroviral drugs, or at least in part.
RFI: For now, only 40,000 doses have been made available in South Africa. President Cyril Ramaphosa has announced that 1 million doses will be supplied within 18 months. However, the organisation Health Gap believes twice that number is necessary to meet the country's needs. If there is a shortage, could patients who start the treatment find themselves in a difficult situation if it later becomes unavailable? What would the consequences be?
NEB: It is a good idea to begin with a certain number of doses and prioritise patients who need lenacapavir the most.
Then, depending on how patients respond to the treatment, it may be possible to increase the number of available doses and expand access to more people.
The risk is that if many doses are distributed and the state is later unable to obtain more, treatment could be interrupted. That could lead to resistance to this antiretroviral drug, which is otherwise very beneficial for patient care.
RFI: Can you explain why there has been more research into HIV treatments than into a vaccine for the virus? Is it really that difficult to develop one?
NEB: HIV is a particularly tricky virus because it mutates a great deal. You can think of it like a burglar who breaks into different houses but changes the way he operates each time.
Perhaps in one house the burglar is 1.8 metres tall, but in the next house he is 1.5 metres tall. That allows him to get through openings that would not have been possible before. He changes his route, he changes his approach. HIV behaves in a similar way because it has many mutations.
Scientists have not yet been able to develop a vaccine that can block all these different mutated strains of HIV. That is what makes creating a vaccine so difficult.
However, there are trials that offer some hope. In particular, the Brilliant 011 trial currently under way in South Africa is giving researchers reason to be optimistic. We hope to see positive results within the next few years.
This interview has been adapted from the original version in French and edited for clarity.
The United States has decided to withdraw all funding for South Africa's HIV and AIDS response through the President's Emergency Plan for AIDS Relief (PEPFAR), a programme that has contributed about $400m (€340m) a year to the country's fight against the disease.
The move comes as relations between Washington and Pretoria continue to deteriorate.
The head of the United Nations HIV agency, Winnie Byanyima, warned that the decision could have serious consequences for public health in South Africa, which has the world's largest HIV-positive population with more than eight million people living with the virus.
Speaking ahead of a UN meeting, she said: "Please do not take money away because you are taking lives away."
Byanyima said the loss of US funding risks undoing years of progress in preventing new infections and supporting vulnerable communities. According to UNAIDS, PEPFAR has been providing around 17% of South Africa's total HIV response funding.
She said: "Taking it away is taking life-saving support from the most vulnerable people."
South Africa does not depend on US funding to buy antiretroviral medicines, as those are financed by the government. However, American support has been crucial for prevention programmes, testing services, community outreach and assistance for groups most at risk of contracting HIV.
The US State Department said the funding withdrawal is part of a "phased drawdown" linked to what it described as South Africa's "failure to make demonstrable progress on policy requests by the administration". US officials have also said the decision was influenced by concerns over the treatment of the country's white Afrikaner minority.
The South African government has rejected those allegations. Pretoria says its Black Economic Empowerment policies are designed to address deep inequalities that persist from the apartheid era. It has also dismissed claims by US President Donald Trump that a "white genocide" is taking place in the country, saying there is no evidence to support the accusation.
South Africa's health ministry said it had not been formally informed of the funding decision but added that it had "long been working on a self-reliance plan". Officials maintain that the country is prepared to assume greater responsibility for financing its HIV response, although experts warn that replacing lost prevention funding will be difficult.
INTERVIEW
'One injection protects up to six months': what is new HIV drug lenacapavir?
As South Africa becomes the ninth African country to introduce the use of new long-acting drug lenacapavir for HIV prevention, RFI spoke with infectious disease specialist Ndong Essomba Bitchoka about how the treatment works, whether the supply will meet demand and why developing an HIV vaccine remains a challenge.
Issued on: 21/06/2026 - RFI
New long-acting antiretroviral treatment lenacapavir requires just two injections a year, reducing the need for daily pills. But questions remain over access, cost and whether enough doses will be available to meet demand in the country with the world's largest HIV-positive population.
Ndong Essomba Bitchoka oversees the HIV/AIDS and tuberculosis care unit at the District Deido hospital in Douala, Cameroon.
RFI: South Africans living with HIV can now benefit from lenacapavir. Can you explain how this new treatment works?
Ndong Essomba Bitchoka: Lenacapavir is an antiretroviral drug. It prevents the assembly of the HIV virus's RNA molecules, which stops new HIV viruses from forming. That is essentially how it works.
[It] can be used to treat HIV infection and help control the virus in certain patients. Instead of taking tablets every day, patients receive injections that limit the virus's replication in the body for around six months.
The patient must first have their condition controlled with oral medicine, meaning tablets. Lenacapavir then supports the action of the antiretroviral drugs already being used to control the virus. The same level of control can then be maintained over a longer period when combined with other medicines.
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RFI: Do you have any idea how much the treatment costs?
NEB: I do not know the exact cost, so I cannot give a precise answer.
In many countries, such as Cameroon where I am from, lenacapavir is not yet available. In many cases, however, governments and financial partners work to subsidise these medicines. So, patients do not have to pay.
But in South Africa, I don't yet know whether that will be the case, but I believe the government is working to see how it can subsidise access to these antiretroviral drugs, or at least in part.
RFI: For now, only 40,000 doses have been made available in South Africa. President Cyril Ramaphosa has announced that 1 million doses will be supplied within 18 months. However, the organisation Health Gap believes twice that number is necessary to meet the country's needs. If there is a shortage, could patients who start the treatment find themselves in a difficult situation if it later becomes unavailable? What would the consequences be?
NEB: It is a good idea to begin with a certain number of doses and prioritise patients who need lenacapavir the most.
Then, depending on how patients respond to the treatment, it may be possible to increase the number of available doses and expand access to more people.
The risk is that if many doses are distributed and the state is later unable to obtain more, treatment could be interrupted. That could lead to resistance to this antiretroviral drug, which is otherwise very beneficial for patient care.
RFI: Can you explain why there has been more research into HIV treatments than into a vaccine for the virus? Is it really that difficult to develop one?
NEB: HIV is a particularly tricky virus because it mutates a great deal. You can think of it like a burglar who breaks into different houses but changes the way he operates each time.
Perhaps in one house the burglar is 1.8 metres tall, but in the next house he is 1.5 metres tall. That allows him to get through openings that would not have been possible before. He changes his route, he changes his approach. HIV behaves in a similar way because it has many mutations.
Scientists have not yet been able to develop a vaccine that can block all these different mutated strains of HIV. That is what makes creating a vaccine so difficult.
However, there are trials that offer some hope. In particular, the Brilliant 011 trial currently under way in South Africa is giving researchers reason to be optimistic. We hope to see positive results within the next few years.
This interview has been adapted from the original version in French and edited for clarity.
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