JOHANNESBURG—African health experts say the continent should prepare for an environment in which it can no longer depend on donations from the United States, following an order from President Donald Trump last week that paralyzed U.S.-funded health services.
Although Secretary of State Marco Rubio issued a waiver allowing projects to continue giving lifesaving medicines and medical services, many facilities aren’t operating fully, with some remaining shut, African health sector professionals told The Epoch Times.
These include projects funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the United States’ flagship health program that gives lifesaving antiretroviral (ARV) treatment to 20 million people, many in Africa.
“HIV patients are still being turned away from clinics that provided ARVs as part of the PEPFAR program because people are terrified of being targeted by the U.S. government if they do something considered to be wrong,” said Foster Mohale, spokesperson for South Africa’s health department.
“Some reopened this week but some are still closed, especially those that provided services to men who have sex with men, sex workers, and trans people,” he told The Epoch Times.
Projects that provide medical assistance to these groups, known as “key populations” because they’re most at risk of getting HIV, are likely to close permanently “as they don’t conform to the Trump administration’s ideology regarding sexuality,” said Mitchell Warren, of AVAC, an international health non-profit working in Africa.
Engage Men’s Health, a Johannesburg-based project providing HIV treatment and prevention medication to the men who have sex with men cohort is one of those PEPFAR-funded groups that remains closed.
“We understand the urgency of your health needs and urge clients to seek care and access ARVs or PrEP [pre-exposure HIV prophylaxis] at their nearest public health facility or healthcare provider.”
The Trump administration says reviews of U.S.-funded aid projects, including PEPFAR, will take at least 90 days. It’ll then decide whether to “continue, modify, or cease each foreign assistance program.”
Sub-Saharan Africa, the poorest region in the world, is the biggest recipient of American aid, which is primarily channeled through the United States Agency for International Development (USAID).
One of the African countries expected to be most impacted by the suspension of assistance from the United States is Kenya, East Africa’s biggest economy and one of Washington’s closest allies on the continent.
The USAID operation in Nairobi is one of the largest in the Southern Hemisphere, employing thousands of Americans and locals.
“Kenya has depended on aid from the United States for many years,” Kenya’s National Treasury Secretary John Mbadi told The Epoch Times.
“We use that money to fund initiatives in education, water and sanitation, agriculture, and economic empowerment. These programs have contributed immensely to reducing poverty.”
He said that Kenyan President William Ruto’s administration would try to reallocate parts of its development budget to ensure that critical programs continue uninterrupted.
“This is going to be very difficult to achieve at such short notice, but we'll try,” Mbadi said.
In Johannesburg, most work at the Reproductive Health and HIV Institute (RHI) at the University of the Witwatersrand has come to a halt, said Shabir Madhi, dean of its Faculty of Health Sciences and a vaccinology professor.
The RHI is PEPFAR’s biggest grant recipient in South Africa, receiving $17 million in 2024 for research on HIV, sexual and reproductive health, and vaccine-preventable diseases.
“It’s a big blow to us as we’re working in collaboration with partners around the world to find new ways to treat and prevent highly infectious diseases and now we can’t deliver what we’re supposed to,” Madhi told The Epoch Times.
“You can’t just down tools with work like this and expect to just pick up where you left off.”
He said USAID served the RHI with a notice last week to stop implementing its Key Populations Program.
“This program and our Trans Health Center obviously reflect diversity, equity, and inclusion, which the Trump administration seemed to target with its stop-work orders,” Madhi said.
Francois Venter, one of Africa’s leading HIV scientists, told The Epoch Times: “People infected with HIV need to take their ARVs every day to keep their immune systems healthy, to prevent drug-resistant HIV, and to prevent them transmitting HIV to others.
“If PEPFAR-funded clinics stay shut for a week, let alone 90 days, people will die and there’ll be many, many new infections.”
Although there are PEPFAR programs across the continent, the initiative is most visible and active in South Africa, the country with the highest HIV burden in the world with about 8 million people infected.
Medical Research Affected
Venter leads Ezintsha, a world-renowned medical research unit in Johannesburg.“In Africa, PEPFAR funds are often used to trace HIV-positive people who’ve stopped treatment so that they can get back on track with medication,” said the scientist.
“So if this funding stops and these individuals fall through the cracks, the consequences could be devastating in terms of new infections.”
Venter said sub-Saharan Africa is set to suffer much more than any other region because of the aid freeze.
“We’re talking here about the poorest countries in the world. You can’t expect other donors or African governments to jump in at the drop of a hat to fill what is a massive gap, in that the United States gives Africa billions of dollars every year,” he explained.
Sasha Stevenson, executive director of African public interest law organization Section 27, told The Epoch Times it’s difficult to predict how the continent’s health systems respond to the loss of U.S. aid.
“They simply haven’t faced a loss of funding on this scale before,” she said. “We’ve had two decades of investment by PEPFAR and USAID which have resulted in tremendous gains across all sectors. Will these gains be maintained? It’s up in the air.”
Greyson Thela, of the Access Chapter health nonprofit in South Africa, told The Epoch Times the “chaos and pain” caused by Trump’s aid freeze shows the continent must look elsewhere for help and must build capacity and finances to deal with its crises.
“The United States has the right to give or not to give as it sees fit. But the speed at which aid has been cut off is just incredibly inhumane,” he said.
‘Key Moment’ to Reflect on Foreign Aid Dependence
Thela said the suspension of American donor funds is a “key moment” for Africans to reflect on the dependence the continent has on foreign aid.“Right now we have many of our people of all sexual persuasions and many vulnerable people, including children, not receiving the medical help they need to stay healthy.
“But is this the responsibility of a foreign government? No. The burden has to be on African governments. They have the sole responsibility to make sure that every single vulnerable population is taken care of.”
Thela said that Trump’s action is also an opportunity for Africans to “reflect on their own morality.”
“We can’t jump up and down in anger because Trump doesn’t want to give aid to members of the LGBT community in Africa when many African governments themselves discriminate against these people and don’t help them,” he stated.
Thela, like many others in African health sectors, said it’s time for public-private partnerships to help fund health care on the continent, with supplemental aid possibly being provided by foreign donors including the European Union and China.
This was echoed by Madhi.
“Governments must step in to address the disruptions, especially in cases where U.S.-funded programs are integrated into government facilities,” he said.
“If staff are employed through U.S.-funded grants, then their services must be shifted to governments so they continue to get paid.”
Professor Hassan Mahomed, a public health medicine specialist at South Africa’s Stellenbosch University, told The Epoch Times he had been “particularly shocked” that Trump’s order had paused research grant reviews at the U.S. National Institutes of Health (NIH).
“Many of us in the medical research field in Africa depend on NIH grants to continue our potentially lifesaving work,” said Mahomed.
“But crucially, Trump’s actions have ended our collaborations with some of the world’s top scientists, collaborations that often yield results that benefit humanity.”
He’s also convinced, though, that developments over the past week should spark a re-examination of Africa’s dependence on external funding.
“Let’s use this unfortunate situation to strengthen alliances in the Global South,” said Mahomed. “Let’s mobilize in the face of this challenge to discuss other sources of funding and to tap into the great wealth of medical expertise that exists across Africa and in countries such as Brazil, Russia, and China.”
