Without lifesaving drugs, South Sudan's HIV patients face a deadly future after Donald Trump's USAID cuts

When US President Donald J. Trump signed an executive order cutting funding to programmes that supported people living with HIV in South Sudan in March, Margaret Jakudu feared the worst. 

An HIV-positive volunteer who works with orphans affected by the virus, Jakudu said the move left her traumatised, worried that without critical support, she and others like her “might die.”

Although the order did not immediately halt the supply of antiretroviral drugs, she has witnessed how it disrupted essential community services that helped bring care to the most vulnerable. 

For nearly 200,000 South Sudanese who live with HIV, funding cuts meant fewer outreach programs, fewer home visits, and a growing sense of abandonment among the patients who relied on them.

“We were pleading with our government to find a solution,” Jakudu said. “It is a big problem. The funding helped us reach those unable to obtain the medicine needed.”

The United States Agency for International Development (USAID) was, after all, the country’s primary donor for HIV treatment, prevention, and care. Years of progress in combating the epidemic that has gripped the nation for decades were threatened, and now thousands were left uncertain about their future.

According to the National Empowerment of People Living with HIV, nearly 1,500 people were left without medication in a matter of weeks following the cuts.

The situation left grassroots organizations, civil society, healthcare workers, and the South Sudanese government scrambling to find solutions, with the acting Minister of Health, James Hoth Mai, stating at one point that “whether there is funding or not,” South Sudan must “find a way to protect its people.” 

A way forward

“The government is working to close the gaps left by Trump’s decision,” said Esterina Novello, Chairperson of the government’s HIV/AIDS Commission. “Efforts are underway to strengthen the country’s “ownership of the HIV response and to reduce South Sudan’s reliance on external donors to avoid similar shocks in the future.”

She went on to explain that in the weeks that followed what healthcare professionals in the country described as a crisis, the Ministry of Health, supported by the United Nations Development Programme (UNDP), implemented a multi-month ARV prescription rollout plan, allowing patients to receive up to six months of medication at once. 

“The relief allowed hospitals to resume a steady supply of the much-needed drugs, and some community outreach services began to return,” she added.

With support from the UNDP Global Fund unit, UN agencies, and other partners, the government has also developed a four-year strategy to sustain HIV care despite the loss of American funding. Officials have also proposed increasing the health sector budget for the 2025–2026 fiscal year, though these plans have yet to materialise.

“With some available resources, including ongoing support from the Global Fund, there is currently sufficient supply for HIV programs, and no major shortages have been reported,” she said. 

Novello assured patients that medical services are now available daily and urged individuals living with HIV to continue taking their medication as prescribed.

"We are trying to reach out to those who cannot make it to health facilities," Jakudu said. "We talk to them, reassure them, and make sure they don’t overthink or lose hope because some of the services are back."

Acol Ayom Dor, a healthcare professional, confirmed that indeed patients are once again receiving antiretroviral medications at health facilities, just as they did before foreign funding was cut.

“As healthcare workers, we’re pushing the government to prioritise health,” she said, adding that greater community awareness about the dangers of HIV is urgently needed, and that can only come with increased government spending.

She noted that the current budget from the Ministry of Finance falls short. 

“Maybe after Trump’s action, there will be a realisation that the health sector budget must be increased,” she said, referring to the ripple effects of U.S. funding decisions.

For now, antiretroviral drugs are secured through 2026. After that, however, “there is no clear way forward,” she told The New Arab.

In addition to governmental efforts, volunteers have also mobilised to deliver ARV medications to patients unable to reach health centres.

HIV positive individuals like Abala Victor Stephen, who has lived with the disease for a decade, were initially overwhelmed with fear when the funding cuts were announced, fearing that without treatment, they would be left vulnerable to the disease. However, now that ARVs are available in hospitals in the short term, those affected have renewed hope.

"Although now there are available drugs and there is limited support, we are crying to our government, civil society, and local organisations to keep us in mind," Abala said, adding that efforts need to intensify, or else the government risks putting the lives of thousands in danger.

The challenges ahead

Despite government pledges, the national HIV response remains on shaky ground. The country still lacks a clear policy on AIDS financing, and there is no long-term strategy to secure sustainable funding, shortcomings that, experts say, jeopardise hard-won progress.

With no immediate solution in sight, they warn that continued delays could force thousands into treatment lapses, raising viral loads and fueling a rise in AIDS-related deaths.

At the same time, chronic resource shortages and limited political commitment, especially at the local level, continue to stall efforts to contain the epidemic and expand access to care.

Civil activist Peter Garang Ngor, Executive Director of the Network of AIDS and Health Service Organizations of South Sudan (NASOSS), a dynamic coalition of civil society organizations working collaboratively to reach a South Sudan free of AIDS, said that following the U.S. funding freeze, civil society groups immediately pressured the government to implement waivers for life-saving HIV interventions, including care, treatment, and the prevention of mother-to-child transmission.

"Civil society organisations have doubled their efforts to improve HIV health outcomes for children, adolescents, and vulnerable families," Garang said. "Our programs aim to reduce HIV infections among adolescent girls and young women, strengthen socio-economic and educational opportunities for orphans and vulnerable children, and expand comprehensive HIV prevention programs for key populations.” 

His group has also worked to boost demand for HIV testing, improve treatment adherence among children under 15 living with HIV, launch targeted awareness campaigns, reduce stigma, and implement community-led monitoring in 22 health facilities across the country.

“The freeze on U.S. aid halted many community interventions designed to serve more than 38,000 beneficiaries,” he explained.

Civil society groups are now pressuring the government to mobilise domestic resources to safeguard the continuity of HIV care and treatment programs. 

“We are calling on national leaders to take full ownership of the country’s HIV response and to prioritise public health investments, beginning with the 2025–2026 fiscal year, in line with the Abuja Declaration’s call for increased health sector funding,” he added.

Ginaba Lino is a reporter at Catholic Radio Network 

This article is published in collaboration with Egab