If the COVID-19 pandemic taught the world anything, it is that vaccines, medicines, and health systems are not merely instruments of public health — they are also powerful tools of diplomacy.
Unfortunately, by scaling back support for ongoing life saving HIV programs, the Trump administration is weakening one of America’s most effective instruments of soft power — especially in South Africa. The long-term beneficiaries of this move are China and Russia, which recognize that health partnerships can translate into geopolitical influence.
Over the next year, the State Department will gradually end the President’s Emergency Plan for AIDS Relief in South Africa due to the country’s failure to institute policy adjustments urged by the current administration. Established in 2003, PEPFAR is the largest government investment ever dedicated to a single disease. It has allocated more than $8 billion to combat HIV/AIDS in South Africa and $100 billion globally.
PEPFAR funding was threatened in 2025, following the reevaluation of USAID and Trump’s executive order denouncing “egregious actions” of South Africa, including policies that discriminate against the white Afrikaner minority, and South African cooperation with U.S. adversaries.
Washington’s concerns about South Africa deserve to be taken seriously. In the executive order, Trump accused South Africa of taking “aggressive positions towards the United States and its allies,” particularly with issues relating to Israel and Iran. South Africa has refused to drop its genocide case against Israel, contrary to Trump administration demands, while South Africa’s director general of foreign affairs said it has no reason to cut ties with Iran. South Africa has not publicly condemned Russia’s invasion of Ukraine and has instead welcomed Russian warships under U.S. sanctions.
These geopolitical moves are concerning. But dismantling PEPFAR in South Africa will likely weaken American influence rather than strengthen it. It creates an opening for countries like China and Russia to step in, and they have already begun to do so. As the U.S. began dramatically decreasing HIV funding for South Africa in early 2025, China committed to a two-year, $3.49 million package to support HIV services in South Africa.
Even more critically, PEPFAR’s absence would likely lead to more than 601,000 HIV-related deaths and 565,000 new infections in South Africa. This death toll will cause irreparable damage to America’s reputation on the continent. Washington’s actions create the appearance of a lack of dedication to global health initiatives and will be seen by African partners as an act of betrayal.
Also, like any other infectious disease, any increased spread of HIV would not be limited to a single geographical location.
Cutting PEPFAR in South Africa also sends a message to other African nations with their own health crises, such as the Ebola outbreak in the Democratic Republic of Congo. Such a move is a signal that America can no longer be a trusted partner in health or — more crucially — sickness. Meanwhile, Russia and China have moved to support Ebola response efforts, reinforcing their presence and partnerships on the continent in America’s absence.
Russia has a history of attempting to discredit the U.S. in Africa, especially with regard to health crises. During the Cold War, the KGB, with the help of the East German intelligence agency, led Operation Denver, a disinformation campaign to convince the world that the Pentagon genetically engineered HIV in a biological weapons lab.
More recently, both Russia and China spread propaganda asserting that the U.S. created COVID as a bioweapon. Following the invasion of Ukraine, Lieutenant-General Igor Kirillov, former commander of Russia’s biological troop protection division, frequently accused the U.S. of creating Mpox and COVID. As of 2024, Russia sponsored 80 documented disinformation campaigns in more than 22 African countries, accounting for almost 40 percent of all disinformation campaigns in Africa.
Today, the retreat from HIV funding offers Moscow fresh material to revive familiar narratives of American hypocrisy and abandonment, which it has eagerly taken advantage of. On June 29, its state-controlled RT News accused the U.S. of “weaponizing HIV/AIDS funding to settle geopolitical scores” in response to South Africa’s failure to conform to its preferred policies. The article emphasized that the U.S. uses aid as leverage for influence, rather than as a genuine commitment to global health.
Another important consideration is America’s image inside South Africa. The African National Congress has been the country’s ruling party since its democratization, and it is closely aligned with Russian and Chinese ideology. The ANC is quickly losing popularity to more Western-aligned parties, and the removal of PEPFAR hands it a perfect lifeline. By accusing the U.S. of betraying South Africa, while having Russia and China step in as replacements, the party can strengthen its domestic image and chances at reelection.
The U.S. would be in a much better position were it to retain its positive reputation in the country and go after the ANC directly instead, by imposing sanctions packages like those authorized by the Global Magnitsky Act.
The lesson is simple: Global health is now a battleground for influence. As the U.S. retreats, Russia will exploit the vacuum with propaganda while China fills it with doctors, laboratories, and medical assistance. The greatest irony is that Washington is surrendering one of its most effective instruments of soft power without a fight. And in geopolitics, vacuums never remain empty for long.
Dr. Ivana Stradner serves as a research fellow at the Foundation for the Defense of Democracies’ Barish Center for Media Integrity. Mark Montgomery is a retired Navy surface warfare officer who commanded a destroyer, a destroyer squadron, and a carrier strike group. He is currently a senior fellow at the Foundation for the Defense of Democracies and co-author of the forthcoming book “Axis of Aggressors.“
