A threat by US President Donald Trump “to cut off all future funding to South Africa” if the US finds its government is confiscating land without compensation has left the treatment of millions of HIV and Aids sufferers in limbo.
Trump delivered the warning on Sunday via his Truth Social platform, where he wrote that South Africa “was confiscating land, and treating certain classes of people very badly”.
“The United States won’t stand for it, we will act,” Trump added. “Also, I will be cutting off all future funding to South Africa until a full investigation of this situation has been completed!”
The US gives annual overseas development aid to South Africa. In 2023 the aid amounted to about $440 million (€426 million). According to South Africa, most of this assistance goes toward delivering the country’s HIV/Aids and TB programmes.
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With nearly eight million people in South Africa living with HIV, of which 5.5 million are receiving treatment, the US assistance is life-saving.
While Trump did not say whose land Cyril Ramaphosa’s administration was confiscating, his outburst appears directed at the South African president’s signing into law of the Expropriation Act last month.
Land ownership has been a controversial issue in South Africa since apartheid ended in 1994, as most farms remain in the possession of white farmers, while most black people remain landless.
Trump adviser Elon Musk, who grew up in South Africa, also weighed in on the debate, asking Ramaphosa on X: “Why do you have openly racist ownership laws?”
The Expropriation Act has been criticised by some parties in the African National Congress-led government of national unity, including the Democratic Alliance (DA), which says the president signed it into law without consulting his coalition parties.
The DA, the Freedom Front Plus, and white interest groups such as AfriForum believe the act is unconstitutional and a threat to private property rights.
AfriForum’s plan to oppose the law includes a legal challenge in the constitutional court. The lobby group promised last month to mobilise international support for its campaign.
On Monday Ramaphosa responded on X to Trump’s comments, saying his government had not taken land without compensation, and that its democracy was rooted in the rule of law, justice and equality.
He also insisted the Expropriation Act was not a legal confiscation instrument, but a constitutionally mandated legal process that ensures public access to land in an equitable and just manner as guided by the constitution.
“South Africa, like the United States of America and other countries, has always had expropriation laws that balance the need for public usage of land and the protection of rights of property owners,” he said.
Ramaphosa went on to call for direct talks with Trump to explain the land reform policies, but later told reporters he will not engage the US president with “a begging bowl”.
It is understood that Ramaphosa also wants to discuss other issues with Trump, including South Africa’s decision to take Israel to the International Court of Justice over its war in Gaza.
Trump’s funding threat has led to renewed panic and confusion in South Africa’s healthcare sector, which last week believed it had received a waiver on the foreign funding freeze the US president introduced within hours of taking office.
On Friday UNAIDS issued a statement saying it welcomed US secretary of state Marco Rubio’s approval of an emergency humanitarian waiver for critical health programmes, as it allowed millions of people globally to continue accessing HIV treatment.
However, Trump’s weekend outburst has raised doubts in South Africa over whether this waiver still applies to the country’s HIV/Aids and TB treatment programmes.
On Sunday, the international medical NGO Médecins Sans Frontières (MSF), which does not accept US government funding, issued a statement urging Trump’s government to immediately resume funding of critical humanitarian and health aid.
“In the last week, MSF’s medical teams have witnessed confusion as clinics and other critical services previously supported by USAID were shut down without warning,” the organisation said.
Gita November, a member of the South African National Aids Council, which brings together the government, civil society and the private sector to create a collective response to HIV/Aids and TB, said USAID-funded HIV/Aids programmes across the country have stalled their operations, and patients have been redirected for treatment at the government’s health clinics.
“We are at the point of looking at how we are going to get through this without US assistance, so we are working with civil society to try to bridge the [funding] gap. But people are going to start dying soon if vital aid and assistance is withheld.”
November said that since the USAID funding freeze the government’s health initiatives had gone back to basics.
“Patients in USAID-funded HIV and TB programmes have been sent to government clinics for basic treatments, but all the other services around HIV have been stopped. In reality, we do not know how local clinics will manage with this increased burden.”
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