Pepfar-funded HIV organisations in South Africa, who receive their funds through the United States Agency for International Development, USAID, woke up to letters that were sent overnight telling them their grants have been ended — permanently.
Pepfar, the President’s Emergency Plan for Aids, is an Aids fund that was launched in 2003 to help fight Aids in countries with high HIV infection rates such as South Africa. The country has since received around $8-billion (about R145-billion) of which $439 537 828 (about R8.1-billion) was for the current US financial year, which stretches from 1 October 2024 to 30 September 2025.
USAID funds 44 health projects in South Africa.
USAID-funded district health projects, supported outside of Pepfar, but with other US government funds administered by USAID, have also been instructed to close down.
The Anova Health Institute , the organisation in South Africa which receives the most Pepfar funding, lost all its funding, a senior Anova Health Institute official confirmed to Bhekisisa . Anova helped to test people for HIV and make treatment available in under-staffed government clinics.
TB programmes funded through USAID also report having received such letters. Letters were also sent to partners of the Accelerating Programme Achievements to Control the Epidemic (Apace), which include large nonprofits such as the Wits Reproductive Health Institute , Broadreach Healthcare and Right to Care .
The Apace projects conducted HIV testing, got people who tested positive onto treatment, got HIV-negative people who needed it onto preventive anti-HIV pills, increased children’s access to HIV treatment and also tested and treated people for tuberculosis (TB), the most common illness that people with HIV get when not on treatment.
WHICH HEALTH PROJECTS DOES USAID FUND IN SA? HERE’S A FULL LIST
It’s not confirmed if all of the USAID-funded organisations received letters, but Bhekisisa has seen confirmation from several projects working on fighting HIV within key populations such as LGBTI+ groups, and also those working with orphans and vulnerable children, to close down their projects immediately.
South African organisations say they have also had reports from Pepfar-funded projects in Kenya and Malawi saying they had received similar letters.
Some organisations received emails, with attached letters, which were signed off with “thank you for partnering with USAID and God Bless America.”
The letters read as follows:
“Dear Implementing Partner,
This award is being terminated for convenience and the interests of the U.S. Government pursuant to a directive from U.S. Secretary of State Marco Rubio, in his capacity as the Acting Administrator for the U.S. Agency for International Development (“the Agency” or “USAID”) and/or Peter W. Marocco, who is performing the duties and functions of both Deputy Administrators for USAID.
Secretary Rubio and PTDO Deputy Administrator Marocco have determined your award is not aligned with Agency priorities and made a determination that continuing this program is not in the national interest. The decision to terminate this individual award is a policy determination vested in the Acting Administrator and the person performing the duties and functions of the Deputy Administrator.
I have been delegated authority to issue this termination notice.
Detailed instructions will follow, and a formal modification/amendment to memorialize this action is forthcoming. Immediately cease all activities, terminate all subawards and contracts, and avoid incurring any additional obligations chargeable to the award beyond those unavoidable costs associated with this Termination Notice. Immediately provide similar instructions to all subrecipients and contractors.
Kindly confirm receipt of this Termination Notice via electronic email response to the sender.
From waivers to nothing
The new Trump administration froze funding globally for all US-funded aid projects on 24 January. It then announced a limited waiver for some projects on 1 February .
Earlier in February, USAID-funded projects in South Africa were asked to apply for 90-day limited waivers , which excluded all HIV prevention activities but most included treatment programmes. They were asked to resubmit work plans that adhered with the waiver rules and also to submit adjusted budgets. But no one had heard back.
Instead, many projects received termination letters last night.
Pepfar projects receiving their funds through the Centres for Disease Control and Prevention (CDC) are still operating. A federal judge ordered the Trump administration in February to allow CDC-funded projects to restart their original projects. But many say they’ve only received funds, so far, to operate until the end of March.
Reaction from health experts in South Africa
With the help of HIV activists, Bhekisisa is gathering responses to the Trump administration’s abrupt cuts of USAID-funded HIV projects. The common theme? South Africa’s national health department isn’t providing the required leadership during this time, with hardly any communication to partners and the media.
Yvette Raphael, co-founder and co-director, Advocacy for Prevention of HIV and Aids (APHA)
“We are deeply concerned about the bad decision to end USAID. The Trump administration has declared war on the right to health globally. The South African government must take this as an opportunity to expedite universal access to healthcare and meet its obligations to our people.”
Sibongile Tshabalala, chairperson, Treatment Action Campaign
“The NGO sector in South Africa woke to a letter from USAID terminating grants. It is so painful that these terminations mean death to poor people of the world. Key and vulnerable populations are the most affected. These terminations happen at a time when the whole world is bewildered by these outrageous decisions by the Trump administration.
“While the Trump administration is fighting for a land Bill that has nothing to do with them and making noise about human rights violations, they are inadvertently committing genocide that will be remembered for years to come.
“It is time for the world to speak up and call the Trump administration out for these unfair decisions.
“We need our government to step up at this moment in time, we need to hold their feet to the fire. The government must act swiftly and come up with a plan to save lives.”
Linda-Gail Bekker, CEO, Desmond Tutu Health Foundation
“Saving dollars and spending lives — no words! We now really need to hear the plans from our country health departments how the chaos will be filled urgently.”
Fatima Hassan, founder, Health Justice Initiative
“One expects a greater sense of urgency and better communication from the health ministry and other departments including the presidency in this time of crisis. They are downplaying the financial and human impact in South Africa, and that will not take us forward.
“As civil society we wrote in early February to the government, asking for its urgent plan, we got no response. We wrote again, and a month later we still await its urgent plan, which shockingly, we learnt from media reports that an assessment is being outsourced to Deloitte and will take a month or longer while right now there is a crisis!
“We spent decades fighting and litigating for the human right to receive proper healthcare services for HIV especially. This is all going up in smoke because of the impact of the Trump administration’s ideological executive orders and actions and its own defiance of court orders in the US — and because our government has no urgent plan to absorb staff, programmes, patients and communities.
“The impact is there for all to see — and frankly, one circular from the national health department which is not even being fully implemented, will not mitigate the chaos. Government should answer — where is the money and where is the plan?”
Kholi Buthelezi, Director, Sisonke
Sex workers are at increased risk for a range of health issues, including sexually transmitted infections (STIs), TB, HIV, and violence-related injuries. In South Africa, access to regular health screenings, education, and preventive care should be a basic right, not a privilege. When a major funding partner like USAID pulls its support, the ripple effects are felt throughout the entire ecosystem of services designed to support these individuals. This is why the government must step up now.”
HIV clinician, speaking anonymously, who has provided the health department with help in its clinics and hospitals via Pepfar 17 years
“Government has to cease the inaction and their seeming return to the behaviour we saw during the worst years of Aids denialism, where politicians let their own opinions impact hundreds of thousands of lives. This cannot be allowed to happen again.
“Eight million South Africans rely on the government’s antiretroviral HIV treatment programme and although Pepfar-funded organisations may only account [along with the health department’s Pepfar funds] for 17% of the budget, what they do with that 17% is so critical.
“Without it, and without an urgent plan to fill the gap, there is no doubt deaths will increase, people will suffer, babies will get infected and die and the monitoring of the programme and its ability to improve and react will become utterly non-existent.
“The SA government must now also be held to account to step in as we have seen with Nigeria and other African countries.”
Anon HIV prevention programme implementer in Gauteng
“Cutting USAID funding for health and education programmes in South Africa isn’t just about budgets — it’s about people. It’s about sex workers who no longer have a safe place to get HIV prevention services, LGBTI+ communities losing the support they fought so hard for and thousands now facing a future without the healthcare and education they rely on to survive.
“These aren’t just numbers on a spreadsheet. They are lives, futures, and communities being abandoned. The reality is heart breaking: people will suffer, people will die, and decades of progress will be undone.
This is not just a funding cut—it’s a betrayal of the very people these programmes were meant to protect. And yet, from the national health department, there is silence. No communication, no coordination, no urgency — just a deafening void where leadership should be.
“The very institutions meant to protect the most vulnerable have offered no plan, no reassurance, no voice. How long must communities wait in fear? How many clinics must close before those in power acknowledge the crisis? This silence is complicity, and it is costing lives”.
Kate Rees, public health specialist
“Our programmes have been officially terminated. Thousands of dedicated healthcare workers across South Africa have been retrenched. I am especially concerned for the community health workers and data capturers, who are financially vulnerable and won’t be easily absorbed into the health system.
“Despite their years of commitment, these healthcare workers have been abandoned with almost no notice. For patients and communities, critical services have already been impacted — including following up on positive HIV tests for babies, following up on possible meningitis cases, and caring for the most vulnerable pregnant women whose babies are now at risk of contracting HIV.”
Public health specialist, anonymous
“This is absolutely shattering, heartbreaking, and incomprehensible. The termination letters issued by the US state department in the last 24 hours mark the abrupt and devastating end to years — decades — of investment in lifesaving programmes that have transformed communities, saved countless lives, and built essential infrastructure for health, education, and development.
“The intellectual capital, expertise, and dedication poured into these programmes have simply been erased by bureaucratic decisions made overnight. How do you quantify the loss of a child’s access to malaria treatment? A mother’s TB medication? A community’s clean water project?
“The people — the patients, the frontline workers, the programme recipients who relied on these services for survival — are now left stranded, abandoned by a system that once promised progress and partnership.
“Every contract cancelled is not just a number; it represents a life, a community, a future now in jeopardy. The sheer disregard for the impact on millions of vulnerable people is unfathomable, and the ripple effects of these decisions will be felt for generations to come.
Mia Malan is the founder and editor-in-chief of Bhekisisa. She has worked in newsrooms in Johannesburg, Nairobi and Washington, DC, winning more than 30 awards for her radio, print and television work.
This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.
