In June 2026, US President Donald Trump’s second administration announced it would eliminate the US President’s Emergency Plan for AIDS Relief (PEPFAR) funding for South Africa’s HIV treatment and prevention initiatives. Although it survived the first round of cuts in 2025, it fell victim to the same logic. PEPFAR has gradually been phased out (unlike the rapid shutdown of USAID) and its absence has left a void that, unless replaced, will dampen HIV/AIDS outreach, diagnoses and prevention, particularly for marginalised groups in the country. Such withdrawals, whether abrupt or phased, reflect the ‘America First’ rationale of the current administration, where aid is replaced by a transactional model in which access to US markets and influence is traded against minerals, data and political alignment.
While sub-Saharan Africa was obligated $17.3 billion in aid from the US and received nearly $16 billion in 2024, that number has plummeted, with only about $1.3 billion obligated for 2026, so far. Proponents argue the savings will be redirected to domestic priorities; critics note that the sums are marginal in the US but decisive in African health budgets. This is not only a US shift: the UK is slashing aid to many African countries and various EU countries are following suit. What distinguishes Washington is the speed of the shift and the explicit substitution of commercial deals for humanitarian and development programming. These cuts will cause real harm to the people who depend on them. The turn toward aid-for-trade also narrows options for African governments, with consequences that affect everything from health outcomes and wages to the environment and security.
The terms offered are often precarious. In the Democratic Republic of Congo (DRC), the US brokered a ‘resources-for-security’ deal. Having claimed credit for a peace agreement covering the conflict with M23, a Rwandan-backed rebel group in the east, the US is positioned to secure minerals such as coltan for its technology sector. The arrangement is being challenged in court by Congolese lawyers and activists, and there is little in its terms to suggest it will raise wages or living standards.
However, not every African government has accepted what is on offer. Ghana rejected a US health deal over a requirement to share sensitive health data; Zimbabwe did the same, arguing that it had no guarantee of benefiting from any research breakthroughs the data might produce. Even if governments accept, courts may disagree, as a Kenyan court did in response to a US health deal. South Africa has had less room to negotiate. Washington has given it the cold shoulder, citing its case against Israel at the International Court of Justice and unsubstantiated claims of racial persecution, even genocide, against Afrikaners. African governments or institutions may recognise that these deals are exploitative and imbalanced and therefore avoid them when possible.
Since the US is not backing down from its new approach to commercial diplomacy (at least for now), African governments must carefully weigh the memoranda of understanding (MOUs) being offered to them. South Africa’s exposure is a warning against over-reliance on any single partner. In 2001, AU member states adopted the Abuja Declaration, which pledged that 15% of government budgets would go to health. By 2024, the average was 7%. The health MOU that Tanzania just signed with the US will provide $1.3 billion in aid over five years, and other African countries are set to follow suit. Before signing, however, governments should weigh these agreements against the risks they carry, from human rights violations to displacement and depressed wages, and against the alternative of a serious reassessment of domestic health financing.
Equitable terms are not beyond reach. Yet the pattern so far suggests a preference for leverage over mutual benefit. Washington claims to have brought peace to the DRC (Trump loves to call himself a peacemaker), but the fighting has not stopped. Extracting minerals in an active conflict zone is not only likely illegal but also risks further rights violations, not to mention the expanding Ebola outbreak that healthcare workers are struggling to contain. The US could write fair wages, environmental protection and security guarantees into these agreements. It has not. What is presented as reciprocity is better described as transactional and, in its terms of exchange, strikingly familiar.
In the counterargument, the administration contends that recasting African states as economic ‘partners’ rather than ‘beneficiaries’ will serve the region better over time. New US funding models could, in principle, support durable infrastructure rather than quick fixes, easing pressure on national budgets and freeing domestic funds for health. Whether that materialises depends on the terms African governments have so far had little hand in setting, and on a capacity for coordinated bargaining the continent has rarely exercised. Without both, the region will not become more self-reliant.
Aid still underpins health and development systems across the continent, but the Trump administration has recast the conversation in transactional terms and has met little resistance doing so. Rejecting an unbalanced deal is hard when need is imperative and harder when the dealmaker is as powerful as the US, yet the alternatives deserve more attention. Governments could adopt innovative health financing, pursue industrialisation and value addition on the continent, or negotiate agreements through the AU – bilateral or collective – on terms that do not undermine their own development priorities.
Africa holds a substantial share of the world’s critical mineral reserves. Transferring them to agreements set elsewhere with little restraint would repeat a familiar pattern. Stepping back from these agreements, at least until the political weather in Washington changes, could buy time to reduce a relationship that has left African economies overly dependent on unreliable foreign governments. African governments should remain sceptical of assistance offered at the cost of sovereignty or reciprocity. For some, self-reliance, or at least less reliance on the US, is the best deal they can make.
