South Africa: China steps in with $3.49 million HIV response fund as U.S. backs down

The grant, announced by Chinese Ambassador Wu Peng ahead of the G20 summit in Johannesburg, will be channelled through UNAIDS and directed toward prevention services for high-risk groups, including young people and people who abuse drugs.

For years, South Africa relied heavily on U.S. assistance to sustain the world’s largest HIV treatment programme. Washington previously contributed roughly 17% of Pretoria’s HIV budget, more than $400 million annually primarily through PEPFAR.

But earlier this year, the U.S. government sharply reduced foreign aid allocations, a decision which triggered concern among health officials and civil society groups, who warned that the move risked widening treatment gaps in a country where over seven million people live with HIV.

In the wake of the U.S. pullback, Pretoria has scrambled to stabilise funding, increasing domestic allocations while searching for alternative external partners.

China’s targeted support, though significantly smaller than the scale of past U.S. assistance, is being welcomed as an important show of commitment at a critical moment.

According to Ambassador Wu, the partnership is intended not only to fund prevention but to help South Africa build a more sustainable HIV response architecture through technology transfer, improved drug supply chains and capacity-building efforts.

Health Minister Aaron Motsoaledi said the new funding strengthens South Africa’s ability to maintain momentum in reducing new infections and supporting vulnerable communities.

South Africa’s relationship with the United States is currently tense, and the country’s exclusion from Washington’s recent HIV drug rollout which included 12 high-burden African nations, has highlighted growing gaps in American support for Pretoria’s HIV response.

Business Insider Africa earlier reported that a new U.S.-backed initiative to expand access to HIV-prevention medication in high-burden African countries kicked off last week with the delivery of roughly 1,000 doses of Gilead Sciences’ long-acting drug, lenacapavir, to twelve African countries that have been earmarked to receive the medication as the programme scales up.

Yet despite carrying the world’s heaviest HIV burden, South Africa was excluded from the rollout, a decision that has sparked concern among health advocates given the country’s central role in the continent’s HIV response.

China, meanwhile, has intensified its diplomatic and development footprint across Africa, increasingly positioning itself as a partner willing to step in where Western commitments recede.

As Pretoria navigates this changing landscape, the country faces the dual challenge of sustaining the largest HIV programme on earth while managing the diplomatic implications of a diversifying donor mix.