No, 100% of South Africa’s HIV/Aids funding does not come from the United States – mostly funded by the South African government

US aid makes up 24% of SA’s largest HIV funding sources

On 21 January 2025, US president Donald Trump signed an executive order, a powerful legislative tool which allows a US president to issue legally binding orders to the federal government, halting all US foreign aid projects for 90 days, pending a review. This included the President's Emergency Plan for Aids Relief, or Pepfar, a global HIV/Aids prevention initiative. On 1 February, a limited waiver was issued by the US government to allow for US funding to be spent on “urgent life-saving HIV treatment services” within certain restrictions. However, further action by Trump meant specifically to penalise South Africa may permanently cut off all US aid to the country.

Cliff was responding to the initial global aid freeze when he posted: “This disgraceful, useless and incompetent government of ours in South Africa is now complaining because Trump has cut foreign aid and it turns out 100% of our HIV positive people get their ARVs from the US.” 

Cliff’s tweet, which was issued with a community note, or additional context contributed by volunteers on X, correcting this false claim, has since been deleted. Various responses to the tweet, also correcting Cliff, are still visible on the platform.

However, Cliff has not issued a correction, and screenshots of his original tweet have been shared on other platforms, where they have gone uncorrected. It is also worth noting that, while the community note, deleted along with Cliff’s tweet, did link to a reliable source, many of the responses to Cliff give differing figures for the percentage of Pepfar contributions.

The correct answer depends on who you ask. A December 2023 report published by the Health Economics and Epidemiology Research Office at the University of the Witwatersrand in Johannesburg estimated the combined budget provided by “the three main funders of the South African HIV response”. 

The largest funder is the South African government, which, according to the research office’s estimate, provided R21.16 billion (approximately US$1.13 billion), or 71% of the funding from the top three funders in the 2023/24 financial year. This was predicted to increase to R21.73 billion ($1.16 billion) in 2024/25, 72% of total funding. 

Pepfar was the second-largest funder, providing R7.06 billion (approximately $377 million), or 24% of the budget, in 2023/24. This was followed by the Global Fund, providing R1.43 billion (approximately $76 million), or 5%. The Global Fund is an international fundraising partnership to which the United States has donated a cumulative $26.3 billion, or around 36% of the $73 billion donated by all public sector donors.

Pepfar directly contributed around 24% of South African HIV/Aids funding. Additional USAid funding indirectly contributed to this budget through initiatives like the Global Fund, but these had other funding sources as well. The majority of HIV/Aids funding, over 70%, has been provided by South Africa’s own government.

This is roughly consistent with the findings of a 2023 study published in the South African Journal of HIV Medicine. This study estimated that in 2019/20, the South African government accounted for 69% of HIV/Aids spending, with additional spending of “24% from Pepfar, 6% from the Global Fund and other international donors and 1% from the private sector”.

But that isn’t the end of the story.

Further antagonism from Trump and funding figures from the South African government

On 2 February 2025, a day after the limited USAid waiver was published, Trump announced his intention to cut off all funding to South Africa, seemingly over a misunderstanding of the country’s newly introduced Expropriation Act. This would mean that even if USAid funding to other countries was eventually resumed, funding to South Africa would still be halted.

In response to Trump, South African president Cyril Ramaphosa said on X: “With the exception of PEPFAR Aid, which constitutes 17% of South Africa’s HIVAids programme, there is no other funding that is received by South Africa from the United States.” (This X post has been edited, and originally read: “... no other significant funding that is provided by the United States in South Africa.”)

South African health minister Aaron Motsoaledi later provided a breakdown of this figure, telling the media: “Seventy-six percent of the funding for HIV/AIDS programmes is from South Africa. This constitutes 74% of funding from the government and 2% from the private sector.” The Global Fund, he said, accounted for 7% of funding, and Pepfar the final 17%. “We are buying ARVs, together with the Global Fund.”

On 6 February, Motsoaledi told Parliament’s Portfolio Committee on Health that South Africa relies on its own funding for approximately 90% of ARVs purchased.

But this doesn’t mean that South Africa’s HIV/Aids response will be unaffected. In 2023, representatives of legal advocacy group Section27 expressed concern that planned South African budget cuts “threatens the hard-won gains we have made and can make toward overcoming this epidemic”. The Wits research office report, quoted above, strongly recommended the scaling up of South Africa’s HIV/Aids response, finding that simply reversing budget cuts could lead to “approximately ~25% more HIV infections averted, AIDS deaths averted and life years saved”.

Even the limited Pepfar waiver “is likely too little, and way too late”, health journalist Mia Malan wrote for Bhekisisa. Some Pepfar-funded health programmes have already been forced to shut down or lay off staff.

Whatever happens, this funding pause will negatively impact South Africa’s HIV/Aids response. But it does not mean that South Africa is totally unable to provide ARVs. The country’s HIV/Aids programmes are much more heavily funded by the South African government than any form of aid from the US.