![\"\"](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2025\/11\/PEPFAR-banner-1-1024x497.jpg\")
South Africa may be excluded from future PEPFAR grants as its relations with the US deteriorate.<\/p>\n\tSouth Africa may be excluded from future PEPFAR grants as its relations with the US deteriorate.<\/p>\n
The United States (US) government has not initiated a meeting with South Africa to discuss the continuation of its HIV grant, and it won\u2019t supply the country with the long-acting HIV prevention medication, lenacapavir, amid a deepening political row between the two countries.<\/p>\n
While US Ambassadors throughout the continent have initiated meetings<\/a> with African Health Ministers to discuss Memorandums of Understanding (MOU) for the continuation of their US President\u2019s Emergency Plan for AIDS Relief (PEPFAR) grants from April 2026, South Africa has not received such an invitation.<\/p>\n \u201cThe Department of Health has not received any correspondence from the US government regarding PEPFAR discussions,\u201d Foster Mohale, South Africa\u2019s Health Ministry spokesperson, told Health Policy Watch.<\/p>\n Neither the US Embassy in South Africa nor the US State Department responded to queries about whether such a meeting is being planned or whether the US has decided to exclude South Africa from future PEPFAR grants.<\/p>\n However, in relation to whether the US would provide lenacapavir to South Africa, a US Embassy spokesperson provided a comment by Jeremy Lewin<\/a>, Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, stating that the US \u201cwill not be contributing doses to South Africa\u201d.<\/p>\n \u201cObviously, we encourage every country, especially countries like South Africa, that have significant means of their own to fund doses for their own population of this innovative American-made drug that Gilead has developed. US-funded doses will not be going to South Africa,\u201d Lewin told a media briefing on 17 November, the day the first 1,000 lenacapavir doses were delivered in Eswatini and Zambia.<\/p>\n Largest HIV+ population Around eight million South Africans are living with HIV, around 13% of the population \u2013 the largest HIV positive community in the world.<\/p>\n In 2024, South Africa received $453 million in PEPFAR funding, and $439 million had been allocated for 2025. But this was suspended when Donald Trump became president on 20 January.<\/p>\n In October, the US government approved<\/a> a $115 million \u201cPEPFAR Bridge Plan\u201d for South Africa for six months from 1 October to 31 March 2026.<\/p>\n Relations between the US and South Africa have been rocky since Trump took office, signing an executive order <\/a>in February to \u201chalt foreign aid or assistance delivered or provided to South Africa\u201d.<\/p>\n The order incorrectly claims that South Africa is persecuting white Afrikaners, and has \u201ctaken aggressive positions towards the United States and its allies, including accusing Israel, not Hamas, of genocide in the International Court of Justice\u201d.\u00a0<\/p>\n The US has offered white Afrikaners refuge in the US, and Trump has made several disparaging remarks about the country, including at a meeting at the White House<\/a> with South African President Cyril Ramaphosa.\u00a0<\/p>\n Earlier this month, the US pulled out of the G20 meeting<\/a> being hosted in South Africa this weekend, with Trump repeating incorrect claims<\/a> of discrimination against whites as the reason.\u00a0<\/p>\n All 2026 lenacapvir stock bought The US government and the Global Fund have bought all of Gilead\u2019s 2026 stock of lenacapavir, a twice-a-year injectable that is almost 100% successful in preventing HIV transmission.<\/p>\n The Global Fund\u2019s HIV head, Izukanji Sikazwe, told Health Policy Watch that her organisation will supply South Africa and all countries in need with lenacapavir \u201cbased on evidence of need\u201d.<\/p>\n But eight patient advocacy groups described the rollout of 500 lenacapavir doses each for Eswatini and Zambia as a \u201cpublic relations stunt\u201d in a media release<\/a> on Thursday.<\/p>\n \u201cAfrica and the Global South are being offered merely symbolic handouts, while Gilead and donors shape markets to serve corporate and geopolitical interests, not urgent public health needs,\u201d said Fatima Hassan, director of the Health Justice Initiative (HJI).<\/p>\n \u201cBy procuring a minuscule number of doses, Gilead can claim that [lenacapavir] is \u2018introduced\u2019 in Africa, creating demand and laying the path for commercial bullying instead of introducing the product at actual cost and at scale. This is a profit-seeking, corporate strategy dressed up as solidarity,\u201d she added.<\/p>\n Gilead announced<\/a> in October 2024 that it has authorised six generic manufacturers to sell lenacapavir in 120 low- and middle-income countries, although none are from sub-Saharan Africa. It also excluded several Latin American countries including Brazil and Colombia.<\/p>\n The medicine is licensed in the US as Sunlenca for people with drug-resistant HIV, and currently costs $42,250 a year for two injections.<\/p>\n The generics are only likely to be available in 2027 at the earliest, and the advocacy groups claim Gilead is \u201cfrustrating the speed at which generic entries are possible\u201d, as it has not yet filed an application with India\u2019s drug regulatory authority and has prioritised registration in only 22 countries.\u00a0<\/p>\n \u2018Insulting\u2019<\/p>\n The advocacy groups estimate that at least 10 million Africans need lenacapavir to achieve the global goal of a 90% reduction in new HIV infections by 2030, with two million of these being South Africans.\u00a0<\/p>\n However, the US will only provide doses for 325,000 people in 2026 \u2013 an \u201cinsulting\u201d amount in comparison to the need, said Bellinda Thibela, Health GAP\u2019s International Policy and Advocacy coordinator.<\/p>\n \u201cInstead of crumbs, the US should be providing millions of lenacapavir doses, to alter the course of the HIV pandemic and to repair the harms caused by their illegal and deadly cuts to HIV programmes since January,\u201d added Thibela.<\/p>\n However, Brad Smith, US Senior Advisor for the Bureau of Global Health Security and Diplomacy, told a media briefing<\/a> this week that Gilead\u2019s available volume in 2026 is 600,000 doses, but that the US and the Global Fund are committed to buying two million doses.<\/p>\n \u201cWe anticipate a continued increase in demand and production capability over time to enable us to meet the two million doses sometime in mid-2027,\u201d said Smith, adding that the doses were being split 50\/50 between the US and the Global Fund.<\/p>\n \u201cWe are working out between ourselves exactly who will distribute and procure for which country,\u201d Smith added.<\/p>\n Speaking at the same media briefing, Gilead CEO Daniel O\u2019Day said his company was able to \u201cprovide Lenacapavir at no profit to Gilead to the countries with the highest burden of HIV\u201d.<\/p>\n Citing the US Executive Order against South Africa, the advocacy groups say that the US\u00a0 has made the country \u201cthe target of harsh foreign policy decisions based on the Trump administration\u2019s racism, lies, and conspiracy theories\u201d.<\/p>\n Nigeria is also being \u201cpushed out\u201d of lenacapavir support \u201cafter being criticised by US government officials, including for refusing to imprison US detainees extracted during US immigration raids\u201d, they claim.<\/p>\n \u201cIn contrast, Eswatini has accepted the offer of not just the 500 lenacapavir doses ahead of World AIDS Day, but also $5.1 million in funding<\/a> from the US government in exchange for imprisoning US detainees,\u201d they note.<\/p>\n Sibongile Tshabalala, Chairperson of the Treatment Action Campaign (TAC), called for either Gilead to license South African generic companies to make lenacapavir, or for the South African government to \u201cuse its lawful powers to issue compulsory licenses\u201d.<\/p>\n \u201cNow that the Trump administration has openly tied the global rollout of lenacapavir to a political standoff rewarding \u2018compliance\u2019 but punishing African political autonomy and sovereignty, South Africa must step forward with principled global leadership,\u201d the groups add.<\/p>\n Image Credits: The Global Fund\/ Saiba Sehmi<\/a>, International AIDS Society<\/a>, Witkoppen Clinic<\/a>, Gilead<\/a>.<\/p>\n Combat the infodemic in health information and support health policy reporting from the global South. Our growing network of journalists in Africa, Asia, Geneva and New York connect the dots between regional realities and the big global debates, with evidence-based, open access news and analysis. To make a personal or organisational contribution click here on PayPal.<\/p>\n","protected":false},"excerpt":{"rendered":"South Africa may be excluded from future PEPFAR grants as its relations with the US deteriorate. The United…\n","protected":false},"author":2,"featured_media":305050,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[18],"tags":[23,3,21,19,22,20,25,24],"class_list":["post-305049","post","type-post","status-publish","format-standard","has-post-thumbnail","category-united-states","tag-america","tag-news","tag-united-states","tag-united-states-of-america","tag-unitedstates","tag-unitedstatesofamerica","tag-us","tag-usa"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/305049","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=305049"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/305049\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/305050"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=305049"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=305049"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=305049"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\n![\"\"](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2025\/09\/Wikoppenen-Clinic-.png\")
A patient getting an HIV test at Witkoppen Clinic, which received PEPFAR for HIV-related services.<\/p>\n
\n![\"\"](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2025\/09\/Screenshot-2024-10-03-at-13.26.31.png\")
Lenacapavir, packaged as Sunlenca in the US, where is sells for $42,250 for two injections.<\/p>\n![\"\"](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2025\/11\/Screenshot-2025-11-17-at-18.51.52-1024x597.png\")
US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenya.
\nPolitical decisions<\/p>\n