JOHANNESBURG (AP) — Civil society organizations in South Africa said Wednesday that adolescent girls and women are among the first vulnerable groups to feel the pinch of U.S. foreign aid cuts as the Trump administration phases out its more than $400 million support annually for the country's HIV programs.

The U.S. State Department has said that it would "begin a phased drawdown" of the President's Emergency Plan for AIDS Relief, or PEPFAR, a program that has supported South Africa's battle against HIV and AIDS for the last 20 years and is widely credited with saving more than 20 million lives over that period.

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The phasing out of most programs is expected to be completed by the end of September, with critical personnel support continuing through March next year, according to the U.S. State Department.

South Africa has the highest number of people living with HIV, with approximately 8 million people, or about 12.7 % of its 63 million population.

The country was singled out for the halting of financial aid in addition to broader foreign aid cuts announced by U.S. President Donald Trump in an executive order issued in January 2025.

Trump announced a halt to all financial aid to the country the following month, citing political issues which included South Africa's Black Economic Empowerment policies and widely disputed allegations of a genocide against the white minority Afrikaner community in the country.

He also cited South Africa's land expropriation laws as targeting white Afrikaners and condemned the country's actions against Israel at the International Court of Justice, where it has accused Israel of committing a genocide in Gaza. Israel vehemently denies the allegation and has said that the attack by Hamas-led militants on southern Israel on Oct. 7, 2023, which killed around 1,200 people, was itself a genocidal act.

A U.S. State Department spokesperson told The Associated Press this week that the South African government had been informed that PEPFAR would be withdrawn if these issues weren't addressed, which included a requirement for senior government officials to "unequivocally condemn all race-based incitement to violence, including the 'Kill the Boer' song, more frequently."

The anti-apartheid liberation song has been interpreted by some as calling for violence against Afrikaners.

According to the South African government, the PEPFAR funding for South Africa was equivalent to about 17% of its budget for HIV programs, but this didn't include the purchase of antiretroviral drugs, since 90% of this was self-funded and the other 10% funded by the Global Fund.

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However, other HIV related programs in 27 districts around the country had been adversely affected, with some support facilities shutting down and front-line workers and volunteers losing their jobs.

"The department has long been working on a self-reliance plan to minimize the impact of funding withdrawal since the initial freeze on foreign assistance and a cancellation of USAID grants in January 2025," South Africa health department spokesperson Foster Mohale said.

Last year, the country announced a $45 million emergency fund to address some of the gaps created by the withdrawal of PEPFAR.

According to civil society group Section27, which has assessed the impact of the funding withdrawals in three districts that have high HIV prevalence in South Africa, prevention services were hardly hit.

"As the health system started to feel the pressure, the response was to prioritize treatment continuity versus prevention," Section27 senior legal researcher Tendai Mafuma said.

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The Anova Health Institute said that it had discontinued its PEPFAR-funded programs and laid off about 3,000 health workers since last year.

"Community delivery of PrEP (preexposure prophylaxis) and prevention services has been heavily impacted," said Dr. Kate Rees, public health medicine specialist at Anova. "Community delivery of prevention is important to reach the people that need it most."

She said that priority populations which include children, adolescents and young people were among the most affected, along with key population which include men who have sex with men and people who use drugs, among others.

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