US Excludes South Africa from New Health Deals Amid Diplomatic Tensions

US Finalizes New Health Agreements Across Africa

The United States government has recently concluded a series of new global health Memorandums of Understanding (MOUs) with at least nine African countries, marking a significant shift in its approach to foreign health assistance. These agreements, signed around December 22-24, 2025, are part of the Trump administration's 'America First Global Health Strategy,' which emphasizes self-sufficiency, co-financing from recipient nations, and reduced long-term reliance on US aid. Countries that have entered into these new agreements include Kenya, Nigeria, Rwanda, Uganda, Cameroon, Eswatini, Lesotho, Liberia, and Mozambique.

The new framework replaces previous health agreements, often administered through the now-dismantled United States Agency for International Development (USAID). These MOUs include clear benchmarks, strict timelines, and consequences for non-performance, aiming to ensure measurable results against priority disease threats such as HIV/AIDS, tuberculosis, and malaria.

South Africa's Exclusion and Funding Halts

Conspicuously absent from the list of signatories is South Africa, a country with one of the world's highest HIV prevalence rates. This exclusion is directly linked to a series of escalating diplomatic tensions and the cessation of substantial US funding earlier in the year. In February 2025, the Trump administration issued an executive order that suspended all foreign aid to South Africa, including critical funding for the President's Emergency Plan for AIDS Relief (PEPFAR).

Previously, South Africa received approximately $400 million to $453 million annually from PEPFAR, which constituted a significant portion of its national HIV budget. The funding freeze led to severe consequences, including:

• The layoff of over 8,000 health workers.
• The closure of 12 specialized HIV clinics.
• Disruptions in HIV testing, care, and treatment services.
• Exclusion from receiving the new HIV prevention drug, lenacapavir, from the US.

While a temporary $115 million 'Bridge Plan' was approved for a six-month period from October 2025 to March 2026 to sustain core life-saving HIV services, the long-term funding remains uncertain.

Underlying Diplomatic Disputes

The US government has attributed South Africa's exclusion and the funding cuts to several political disputes. The Trump administration cited South Africa's foreign policy positions and 'unsubstantiated claims about the persecution of white Afrikaners' as reasons for the strained relations. The executive order in February 2025 incorrectly claimed that South Africa was persecuting white Afrikaners and had 'taken aggressive positions towards the United States and its allies, including accusing Israel, not Hamas, of genocide in the International Court of Justice.' South Africa's decision to file a case with the International Court of Justice (ICJ) accusing Israel of genocide in the Israel-Hamas conflict was also a contributing factor to the tensions.

Further exacerbating relations, the US State Department condemned South Africa's detention of US officials, claiming they were providing humanitarian support to Afrikaners. South Africa, however, denied any arrests of US officials, stating they had detained Kenyan nationals working illegally.

Conclusion

The recent signing of health deals with other African nations, coupled with South Africa's exclusion and the ongoing funding cuts, underscores a significant shift in US foreign policy under the current administration. This new transactional approach prioritizes US interests and bilateral negotiations, leaving South Africa to grapple with the substantial impact on its public health infrastructure, particularly its fight against HIV/AIDS. The future of US-South Africa health cooperation remains uncertain amidst these deepening diplomatic rifts.