On 26 February 2025, the United States terminated 90% of global projects administered by USAID under PEPFAR, cutting R7.9 billion (about $420 million) from South Africa’s HIV/AIDS response overnight.
The abrupt halt stripped funding from 70% of healthcare facilities, forced clinic closures, scaled back gender-based violence and HIV prevention programmes, stalled essential research and clinical trials, and left over 8,000 people unemployed.
Despite the shock, Minister of Health Aaron Motsoaledi noted that domestic resources already covered around 74% of the national HIV response and financed 90% of antiretroviral treatment, while the Treasury added R753 million (about $40 million) for a treatment awareness campaign.
The Bill and Melinda Gates Foundation and Wellcome Trust each pledged R100 million (about $5.3 million) for research, conditional on Treasury matching of R200 million each, and UNAIDS urged a coordinated donor response, proposing a South African Solidarity Fund Against HIV modelled on the COVID-19 initiative.
Doctors Without Borders provided independent resources to keep some HIV and TB clinics operational, and the Elma Foundation issued emergency bridging grants to NGOs as civil society moved to fill the gaps.
Research sector scrambles to sustain momentum amid funding chaos
South African health research, particularly in HIV and tuberculosis, had long relied on US National Institutes of Health funding, receiving more direct grants than any other country outside the US.
Disruptions began in January 2025 with a 90-day pause on international aid, intensified in February when the Trump administration specifically cut support to South Africa over policy disagreements fueled by disinformation, and escalated in May 2025 when the NIH barred foreign sub-awardees from receiving funding through US-based grantees.
Implementation remained chaotic for over a year, though softening in June 2025 allowed temporary pathways for ongoing human trials to continue.
In August 2025, the South African Medical Research Council announced it had raised about R600 million (roughly $32 million) in rescue funds to protect the health research ecosystem, emphasizing that infrastructure, personnel, projects, and platforms built over decades could not be allowed to collapse.
For more on this story, see South Africa Receives First Shipment of Lenacapavir HIV Prevention Injection.
Science and innovation department outlines strategy to navigate global pressures
The Department of Science, Technology and Innovation unveiled its 2026-27 annual performance plan amid declining R&D expenditure as a share of GDP, constrained national finances, and the withdrawal of US funding from joint science projects.
Despite fiscal limits, the department pledged to maintain and upgrade strategic infrastructure including the Square Kilometre Array and Nuclear Medicine Research Infrastructure while mobilizing resources for AI, energy security, space science, vaccine innovation and manufacturing, and Indigenous Knowledge Systems.
The department aims to drive South Africa toward the government’s target of 1.5% of GDP by 2030 for gross expenditure on research and development, strengthen policy coherence through the STI Presidential Plenary and Inter-Ministerial Committee, and accelerate transformation of the National System of Innovation by expanding human capital and the research workforce.
It announced the rollout of 41 new research chairs, prioritizing support for black and women scientists to build a more inclusive generation of researchers, framing the plan as a delivery year focused on coordination, efficiency, and ensuring every rand of public investment produces system-level impact.
This follows our earlier report, US Funding Shifts Put Global HIV/AIDS Programs at Risk.
How much of South Africa’s HIV response was funded by PEPFAR before the cuts?
In February 2025, PEPFAR funding accounted for R7.9 billion, or 17%, of South Africa’s total R46.8 billion HIV/AIDS response.
What condition did the Gates Foundation and Wellcome Trust attach to their R100 million research pledges?
Each foundation pledged R100 million for HIV research on the condition that the National Treasury match it with R200 million.
What specific action did the NIH take in May 2025 that affected foreign research partners in South Africa?
The NIH announced that foreign research groups working with US-based grantees could no longer receive funding as sub-awardees for new or renewing grants and would need to apply independently for “linked” research funding.
How much rescue funding did the SAMRC raise by August 2025 to support affected research projects?
The South African Medical Research Council raised about R600 million in rescue funds to support research projects and groups impacted by the US funding cuts.
