Physicians for Human Rights (PHR) reported that cuts to United States global health funding, begun in 2025, have degraded South Africa’s HIV response more than a year on, with community testing, clinic services and health data all weakened. The group documented the damage through oral-history interviews with front-line workers and patients, and re-contacted every participant in March 2026 to confirm the accounts. By late March 2026, it said, programmes fighting HIV, tuberculosis and malaria across several countries remained impaired, and Africa was the worst affected.

The funding shift dated to early 2025, when the Trump administration reduced and disrupted global health aid. An executive order halted foreign aid, and research funding to South Africa was cut on the basis of unsubstantiated allegations of “white genocide.” The President’s Emergency Plan for AIDS Relief, known as PEPFAR, lost programmes across the country, and much of the work funded through the United States Agency for International Development, or USAID, ended.

The replacement plan has not arrived. The America First Global Health Strategy, a State Department approach to foreign aid that requires recipient countries to co-invest, was unveiled in September 2025 and covers HIV, malaria, tuberculosis, polio and broader health security. As of April 2026, PHR reported, the strategy had received no funding and had not been put into practice. The United States had also not pursued a memorandum of understanding (MoU) with South Africa, the interim mechanism that in other countries has kept some prior investment from being lost.

A concentration problem

South Africa carried an unusually large share of that prior investment. Before 2025 it received the most direct funding from the National Institutes of Health (NIH) of any country outside the United States, alongside support from the Centers for Disease Control and Prevention and USAID, the report said. The country also bears the world’s largest HIV epidemic, with high and lasting infection rates among adolescent girls and young women. It funds most of its HIV programme from domestic resources, and United States money made up about 17 per cent of the response in recent years, against 80 to 90 per cent in some other countries.

That 17 per cent was not spread evenly. It paid for the parts of the programme that reach the hardest-to-serve patients, the report said, including services for adolescent girls and young women, sex workers and other key populations, paediatric HIV diagnosis, data collection and community-based testing. The loss of a single donor supplying a concentrated slice of a health system is the same exposure that recurs on the demand side of cross-border care, where a destination built on one source market inherits that market’s politics. PHR urged the mirror-image remedy, that South Africa reduce reliance on a single donor and expand domestic resource mobilisation, a government financing choice that decides whether a system can stand without a dominant backer. South Africa’s medical tourism pitch rests on the same private hospitals and research base now under strain, a claim set against the country’s own numbers in earlier coverage.

What the interviews found

PHR and its partners, Advocates for the Prevention of HIV in South Africa and Emthonjeni Counseling and Training, conducted 20 oral-history interviews with 40 participants in September 2025. The participants included doctors, nurses, clinical officers, peer counsellors, government health workers, researchers and people living with HIV.

In the community, street-level HIV testing has largely stopped, the report said, and testing has moved inside clinics where wait times are long. Where United States-funded groups ran the outreach, some services stopped when the money ended. Facility care has also thinned. One woman returning to PrEP was told by an overstretched nurse that staff now “test you when you ask” rather than as routine, the report said. Health workers who once traced patients who missed visits and drew them back into treatment have been lost.

Data has degraded alongside the services. Clinic staff described backlogs in data entry that left them unable to tell whether patients recorded as disengaged had in fact collected their medicine. “I’m waiting for a big bomb to blow on our face at any time,” a government data-quality officer said, describing treatment gaps the system could no longer see. Timely data is what lets a programme send a home visit to a patient who missed a refill or target an area with rising infections, the report said, and without it a surge can build unobserved.

Research infrastructure at risk

The cuts also reached research. Before 2025, South Africa received an estimated $100 million to $150 million a year in direct NIH grants, and about $400 million once sub-grants were counted, on top of PEPFAR funds, the report said. The NIH then cut research and grant funding, declined to renew awards for ongoing clinical trials, and barred foreign sub-award grants. South African researchers called the losses severe.

That joint work produced results the United States used. It fed into the injectable PrEP drug lenacapavir and the Xpert MTB/RIF test for tuberculosis, the report said. Efficient trials for HIV prevention need communities with high infection rates and a strong research base, a mix South Africa had built over years. PHR is an advocacy group, and its account rests on testimony rather than audited programme data, a limit it states plainly.

What to watch

The test is dated and measurable. Whether the America First Global Health Strategy is funded and running before the next year’s HIV figures appear will show whether it was a strategy or an announcement. South Africa’s next infection and treatment-retention data will show whether domestic financing has closed the 17 per cent gap or whether new infections have begun to climb. The MoU that had not been signed by April 2026 is the specific document to watch, because it is the mechanism that decides whether a decade of investment transfers or lapses.