‘The axe has fallen’ — Trump's USAID issues notices to terminate funding for key health programmes across SA

Just 38 days after US President Donald Trump signed an executive order imposing a 90-day freeze on all foreign development assistance pending a review, the United States Agency for International Development (USAID) has issued notices to Pepfar-funded HIV organisations terminating their funding for good.

The notices went out overnight on Wednesday, 26 February, leading to consternation among health workers and activists in the HIV/Aids sector as key programmes face the imminent collapse of their services.

“What I’ve seen this morning … is great upset and devastation, because this affects people who have literally put their hearts and minds and imagination and lives into building novel, groundbreaking programmes, which have taken many years and have suddenly just been terminated,” said Mark Heywood, a health and human rights activist with a long history of work in the HIV/Aids sector.

“The axe has effectively fallen, and we have moved from ‘cease work’ suspension notices to actual termination.”

Mark Heywood. (Photo: Joyrene Kramer)

Pepfar (the US President’s Emergency Plan for Aids Relief), a global health programme started in 2003, provided South Africa with about $440-million in funding for the US financial year spanning October 2024 to September 2025. It constituted 17% of South Africa’s R44.4-billion campaign for HIV counselling and testing, according to Health Minister Dr Aaron Motsoaledi.

Pepfar funds are distributed to South African implementing partners by USAID and the Centers for Disease Control and Prevention. About half of the Pepfar-supported programmes in SA receive funding through USAID.

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Termination of key services

In a letter issued to implementing partners by USAID, it was noted that the terminations were “for convenience and the interests of the US Government”. Organisations were informed that their programmes were “not aligned with agency priorities” and “not in the national interest”.

“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,” stated the letter.

It’s not just South African organisations whose funding is being axed.  Trump’s administration has stated that USAID made a final decision to cancel nearly 5,800 awards, while retaining more than 500, according to a Reuters report. The cut also affected health programmes that were supported by USAID funding from sources other than Pepfar.

Among those international organisations that received a termination notice from USAID was the United Nations Programme on HIV/Aids.

The Wits Reproductive Health and HIV Institute — a renowned research institute that specialises in HIV/TB, sexual and reproductive health, vaccines and infectious diseases — confirmed that it had received termination notices.

“Based on these notices, we have no alternative but to close down the programme to mitigate risk to other funded activities. This is a difficult time for all Pepfar partners as we simultaneously manage the employee challenges and explore solutions to ensure continuity of care and support for patients and beneficiaries affected by this abrupt announcement,” said Sagie Pillay, chief operating officer at the Wits Health Consortium.

The Anova Health Institute, an organisation that assisted the SA public health system with TB and HIV care, lost all its funding. Dr Kate Rees, a public health specialist at Anova, said that on Friday the organisation would let go of more than 2,800 workers as a result, including counsellors, data capturers and healthcare workers.

“These people are not going to find other jobs very easily. They’re not ready and waiting for them,” said Rees during an online press conference hosted by Community Health and HIV Advocates Navigating Global Emergencies (Change) South Africa on Thursday.

While the exact number of South African organisations affected was not immediately clear, Lynne Wilkinson, a Gauteng-based public health specialist in the HIV/Aids sector, said she had yet to hear of any USAID-funded health programme that hadn’t received a termination notice.

‘Pushed off a cliff’

In SA, Pepfar funding has been focused on “hard-to-reach gaps”, such as supporting children and pregnant women, and key population and community-based services, according to Wilkinson.

A young boy is tested for HIV at the Right To Care Aids clinic in Johannesburg, which was funded by Pepfar. (Photo: Cornel van Heerden / Gallo Images / Foto24)

“This wasn’t a duplication of government services. It was complementary, providing that final push to achieve those 95-95-95 targets and reduce our infections and our HIV and TB mortality. This is the entire HIV and TB programme put at risk of unravelling across public sector facilities, communities and key population services,” she said.

Wilkinson noted that the impacts of the USAID terminations included:

• The loss of most data capturers at public health facilities, which affected monitoring and evaluation efforts;


• Minimal HIV screening for children in maternal and child services;


• Limited support for advanced HIV disease services, which serve high-risk patients such as pregnant women;


• The potential loss of pre-exposure prophylaxis services for adolescent girls, young women and pregnant women, who would be cut off from critical HIV prevention tools;


• Limited TB screening and testing


• Loss of mobilisation for HIV testing;


• The closure of youth and family care clubs; and


• The closure of drop-in centres, clinics and mobile outreach initiatives for key populations.

USAID funding has also played a large role in support services for gender-based violence survivors.

“We already know of 87 facilities that were providing post-violence care for 33,000 survivors last year whose services will disappear. These are survivors of rape and intimate partner violence with no post-exposure prophylaxis to prevent HIV infection, no psychosocial support or legal assistance,” said Wilkinson.

Linda-Gail Bekker, the chief operating officer of the Desmond Tutu HIV Foundation, identified several research projects that would be affected by the termination of USAID funding, including the Matrix Project, which was testing short-acting methods of pre-exposure prophylaxis that could be combined with contraception.

“Clinical trials were actually in the field and were stopped at the end of January, and they will not be resumed now,” she said.

Professor Linda-Gail Bekker. (Photo: Desmond Tutu Health Foundation)

Three clinical trials had been lined up for testing an affordable HIV vaccine in eight African countries, said Bekker. These had now been halted, “with the immunogen sitting in the fridge, not able to be used”.

Anova’s Rees noted that it had taken decades of investment to build up the systems that allowed Pepfar-funded partners to fill gaps in the strategy for combating HIV.

“These are now being destroyed in one month. Plans were in place to shift the partner programmes to become more and more sustainable for [the National Department of Health] to … take ownership of over the next five years. And now, instead of a careful handover, we’ve been pushed off a cliff,” she said.

Call to action

At the Change South Africa press conference on Thursday, health experts and activists called on the South African government to take urgent action to address the gaps left by the termination of USAID funding.

“We stand to lose all the investment over the last 25 years if we do not work hard to fill the gaps that this funding freeze is causing. Secondly, we will see lives lost. In excess of half a million unnecessary deaths will occur because of the loss of the funding and up to a half a million new infections, [according to] modelling studies,” said Bekker.

“It is not hyperbole to say that I predict a huge disaster, a walk-back on the investment, unless other resources can be found and found urgently.”

Wilkinson spoke of the emergency circular issued by the health department’s director-general, Dr Sandile Buthelezi, on 11 February, detailing the measures that formed part of the “contingency plan” to respond to the temporary suspension of support from Pepfar and its implementing partners.

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“Issuing the emergency circular was an important, necessary first step... Beyond this, government must urgently develop a short- and medium-term plan, including emergency funding allocations to sustain the service delivery [and] redeployment of trained healthcare workers and community staff to ensure the continuity of care,” she said.

“We can’t afford delays right now.”

Court challenges

Trump’s executive orders have seen him make sweeping changes to US policy, resulting in several lawsuits and pushback from democratic legislators. His administration’s efforts to slash foreign aid funding through USAID and state departments have not gone unchallenged.

US President Donald Trump. (Photo: Bonnie Cash / EPA-EFE )

On Tuesday, 25 February, Washington-based District Judge Amir Ali gave the administration two days to unfreeze foreign aid, after it reportedly failed to comply with a previous court order to disburse funds to aid groups around the world, according to The New York Times. This was after two health organisations brought a lawsuit against Trump’s executive order suspending almost all funding pending a review.

However, Reuters reported that US Supreme Court Chief Justice John Roberts paused Ali’s order on Wednesday, 26 February, giving “no rationale” for his decision. Roberts’ order came after the Trump administration said in a court filing that it had made final decisions terminating most foreign aid contracts and grants, bringing an end to the review period.

The plaintiffs in the case were given until noon on Friday to respond.

While these court proceedings are ongoing, the outcome — whether in favour of the plaintiffs or not — will not reverse the damaging effects that the USAID termination notices have already had on South African and global implementing partners. DM