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Economics

Cuts to US Aid Imperil the World’s Largest HIV Treatment Program

In South Africa, clinics serving marginalized groups—migrants, gay men and sex workers—are shutting down as funds dry up.

Patients begin lining up outside the Witkoppen Clinic in Johannesburg before dawn.

Photographer: Marc Shoul for Bloomberg Businessweek

For more than two decades, the US was the leader in global efforts to treat and prevent HIV infections. Washington funded lifesaving antiretroviral therapy for more than half of the estimated 40 million people living with HIV around the world, along with community counseling and technical assistance largely through the US President’s Emergency Plan for AIDS Relief (Pepfar), which since its inception in 2003 has distributed more than $120 billion in funds.

Programs in 50-plus countries are losing that vital American support as President Donald Trump’s administration reviews and rolls back foreign aid. Among the biggest victims is South Africa, a country that remains the epicenter of the AIDS pandemic, with almost 8 million people—equal to 13% of the population—living with HIV. US federal funding for programs administered by the government and charitable organizations totaled about $440 million a year, according to South Africa’s health ministry.