Imagine losing 17% of your HIV response overnight. That is the reality South Africa could face if Washington pulls the plug on PEPFAR support.

UNAIDS Executive Director Winnie Byanyima said on Monday she was saddened by US plans to withdraw HIV/AIDS funding for South Africa. She is calling on Washington to reconsider, warning that the decision could cost lives in the country carrying the world’s heaviest HIV burden, cbinews.tv reports.

Speaking at a UN news briefing ahead of a high level conference on HIV/AIDS, Byanyima cautioned that wider global aid cuts are threatening to undo decades of hard won progress. She said, “We are seeing early signs of serious reversals. The trend that has been going down may now reverse and start rising.”

The US State Department confirmed the move in an emailed statement to cbinews.tv, saying America has “decided to initiate a phased drawdown” of the President’s Emergency Plan for AIDS Relief (PEPFAR) in South Africa. The reason given was South Africa’s failure “to make demonstrable progress on policy requests by the administration.”

Washington argues PEPFAR was never meant to be permanent and that South Africa, as a middle income country, “is more than capable of supporting its own health programmes.”

But the politics behind it may run deeper. As reported by Semafor last week, a State Department official and two congressional aides said the decision was tied to US demands that Pretoria scale back its partnership with Iran, scrap Black Economic Empowerment policies, and address the “Kill the Boer” anti apartheid chants.

US President Donald Trump froze many foreign aid programmes early in his presidency, later reinstating some lifesaving assistance, including parts of PEPFAR.

South Africa does not rely on US money for its HIV drugs. Still, PEPFAR used to pump more than $400 million a year into the country and covered salaries for about 15,000 health workers. Byanyima said South Africa has roughly 8 million people living with HIV, the most anywhere in the world, and the US programme had been funding up to 17% of its HIV response.

The bigger picture is concerning. Byanyima flagged a steep drop in development assistance from traditional donors across Europe and North America, just as the world aims to end AIDS as a public health threat by 2030.

There has been real progress. Around 32.1 million of the estimated 40 million people living with the virus are now on treatment. But it remains fragile. UNAIDS data shows 9 million people still lack treatment, and 1.2 million were newly infected last year.

And the cracks are already showing. Byanyima said HIV testing in high burden countries has dropped by 22%, while some nations have seen condom distribution collapse by 90%. Funding cuts, she warned, are already disrupting services and could spark a rebound in infections.

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