Trump’s Foreign Aid Ban Exempts South Africa’s Pepfar HIV Program—For Now

South African HIV programs funded through the US President’s Emergency Plan for AIDS Relief (Pepfar) have received a temporary exemption from US President Donald Trump’s recent executive order halting foreign aid to South Africa. While this waiver allows Pepfar-funded projects to continue until April, uncertainty remains over their long-term future.

Pepfar Funding Gets a 90-Day Waiver

A senior US embassy official in Tshwane confirmed that the aid ban does not apply to lifesaving humanitarian programs such as Pepfar. However, this exemption is only valid for 90 days, ending in late April, and applies only to approved activities announced on February 1.

For the current financial year (October 2024–September 2025), Pepfar has allocated $439 million to South Africa. The funding is primarily distributed through the US Agency for International Development (USAID) and the Centers for Disease Control & Prevention (CDC), supporting both the national health department and NGOs that implement HIV programs.

Despite the exemption, confusion remains. Many South African projects are still waiting for formal approval letters from their US funding agencies, leading to delays in restarting critical services.

What Services Are Covered?

According to a February 6 memo from the US State Department, the waiver covers essential HIV treatment and care, including:

• Salaries for healthcare workers
• HIV testing and treatment
• Mobile clinics and drop-in centers for high-risk individuals
• Prevention and treatment of tuberculosis in people living with HIV

However, some key services remain excluded. Notably, pre-exposure prophylaxis (PrEP) for anyone other than pregnant and breastfeeding women has been put on hold. This decision is particularly concerning as South Africa has the highest number of PrEP users globally, with 1.65 million people having accessed the medication.

A Chaotic Policy Shift

Trump’s executive order is part of a broader ideological shift, targeting foreign aid programs that do not align with his administration’s stance on issues such as gender identity, reproductive rights, and diversity and inclusion policies. This has led to uncertainty for Pepfar partners in South Africa, many of whom are unsure whether their programs will continue beyond April.

Mitchell Warren, an advocate from the New York-based organization AVAC, which receives Pepfar funding, describes the situation as chaotic. “Understanding how to operate under these conditions is filled with confusion. This not only disrupts short-term programs but also damages long-term relationships between countries and communities,” he said.

What Happens After April?

While Pepfar projects have been granted a temporary reprieve, the long-term future of HIV prevention and treatment programs in South Africa remains uncertain. The US government is conducting a 90-day review to determine whether existing programs align with the Trump administration’s policies.

If the waiver is not extended, South Africa could lose crucial funding for PrEP, HIV prevention among vulnerable groups, and implementation science projects studying new treatment methods. The country’s health department has not yet announced a contingency plan to mitigate these potential losses.

Warren warns that the biggest winner in this scenario is the HIV virus itself. “HIV thrives in chaos, instability, and uncertainty. If Pepfar funding is cut, it will create a devastating setback for South Africa’s HIV response,” he said.

The temporary waiver for Pepfar-funded programs in South Africa is a relief, but it does not guarantee future funding. With Trump’s administration reviewing foreign aid policies, South Africa’s HIV programs could face significant challenges in the months ahead. As the April deadline approaches, stakeholders are left waiting to see whether the exemption will be extended or whether critical HIV services will be forced to shut down.

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