Africa (Commonwealth Union) _ Concerns over the spending patterns of USAID have recently put their activities under scrutiny. Allegations of USAID links to organizations associated with Hungarian-American billionaire George Soros over the last 15 years have also been in focus across the world. The current US administration has stated that USAID was using a large proportion of US taxpayers’ money to fund regime change and political activities across the globe. However, some humanitarian activities were also funded via USAID; hence, distinguishing between legitimate use of the funds and ignoring any illegitimate use would likely be the focus of the current US administration.
DOGE Subcommittee Chairwoman Marjorie Taylor Greene in a recent hearing said, “USAID has been transformed into an America-last foreign aid slush fund to prop up extremist groups, implement censorship campaigns and interfere in foreign elections to force regime change around the world,” she said. “That is the dark truth about USAID. That is the story the American people need to know.”
Recently, multiple South African HIV organizations funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID) were notified of the immediate termination of their grants. The abrupt move has sent shockwaves across the public health sector, leaving critical programs in limbo and threatening the progress made in HIV/AIDS treatment and prevention over the past two decades.
Launched in 2003, PEPFAR has provided essential funding to combat HIV/AIDS in high-burden countries like South Africa, which has received approximately $8 billion (about R145 billion) since the program’s inception. The current U.S. financial year alone allocated $439.5 million (R8.1 billion) to the country. USAID funds 44 health projects in South Africa, many of which now face imminent shutdown.
In addition to PEPFAR-backed programs, other USAID-funded district health projects not linked to PEPFAR but supported through alternative funding from the U.S. government have also been instructed to close. The Anova Health Institute, the leading PEPFAR-funded entity in South Africa, played a crucial role in HIV testing and treatment within under-resourced public clinics. Tuberculosis programs funded by USAID have also reported receiving termination notices.
According to reports, PEPFAR-funded organizations in Kenya and Malawi are experiencing similar funding cuts, suggesting a broader regional impact. Some of the termination emails reportedly ended with the phrase, “Thank you for partnering with USAID, and God Bless America.”
The letters issued to implementing partners cite a policy directive from Acting USAID Administrator, U.S. Secretary of State Marco Rubio, and Deputy Administrator Peter W. Marocco. According to the notice, the terminated programs were deemed misaligned with agency priorities and not in the national interest. Organizations were instructed to immediately cease operations, terminate sub-awards and contracts, and refrain from incurring additional costs.
This decision follows a global freeze on U.S.-funded aid projects implemented by the Trump administration on January 24, with a limited waiver for select programs announced on February 1. The Trump administration later permitted some USAID-funded projects in South Africa to apply for 90-day waivers, which excluded HIV prevention activities while preserving some treatment programs. However, no feedback was provided to applicants, and instead, termination letters were abruptly issued.
Programs receiving PEPFAR funding via the Centers for Disease Control and Prevention (CDC) remain operational, following a U.S. federal court ruling in February that ordered the Trump administration to resume funding for CDC-backed initiatives. However, even these programs have only secured funding through the end of March.
A veteran HIV clinician working in South African public hospitals through PEPFAR for 17 years described the cuts as reminiscent of the country’s darkest era of AIDS denialism. “Eight million South Africans rely on government-provided antiretrovirals, and while PEPFAR contributes only 17% of the budget, its impact is far greater. Without urgent intervention, mortality rates will climb, treatment adherence will collapse, and decades of progress will be lost.”
Fatima Hassan, founder of the Health Justice Initiative, expressed frustration over the government’s lack of response. “Civil society wrote to the government in February asking for an urgent plan. A month later, there’s still no response. Instead, we hear through media reports that Deloitte has been contracted to conduct an impact assessment that will take another month. This is a crisis unfolding in real time, and our government is absent.”
Public health specialist Kate Rees highlighted the devastating impact on healthcare workers. “Thousands have been retrenched overnight. Community health workers, who are among the most vulnerable, will find it difficult to find employment elsewhere. The government must step in now.”
US Secretary of State Marco Rubio recently made a statement regarding a waiver of cuts to life-saving humanitarian assistance. The move may open up the possibility of affected agencies appealing any cuts.
