The United States State Department is reportedly threatening to cut HIV/AIDS and other disease prevention funding for over a million people in Zambia to pressure the country into granting greater access to its mineral resources. A draft memo prepared for Secretary of State Marco Rubio indicates that the US intends to demonstrate its priorities by publicly withdrawing support on a massive scale if Zambia does not comply.
The Trump administration is considering significant reductions to the President’s Emergency Plan for AIDS Relief (PEPFAR), which currently provides daily HIV treatment to approximately 1.3 million Zambians, as well as funding for tuberculosis and malaria programs that save tens of thousands of lives annually. PEPFAR has dramatically reduced HIV-related deaths in Zambia, from 90,000 per year in 2003 to 16,000 in 2024, according to UNAIDS data.
Threats to cut aid are part of a broader strategy by the Trump administration to leverage foreign medical assistance to secure economic and strategic concessions from developing nations. Many African countries have signed memoranda of understanding under the “America First Global Health Strategy,” often agreeing to increase domestic health spending or comply with ideological conditions to access reduced US funding. Some nations, including Zimbabwe, have rejected such deals, citing exploitative terms and data-sharing requirements.
Zambia’s proposed agreement would require the country to commit $340 million in health spending to receive $1 billion over five years, less than half of previous funding levels. It also demands that Zambia share citizens’ health data with the US and grant easier access to its substantial mineral reserves, including copper, lithium, and cobalt, essential for green energy technologies. Zambia rejected the deal, stating that it does not align with national interests.
The potential cuts to PEPFAR could have severe consequences for Zambia’s healthcare system. Many clinics have already faced disruptions in testing, treatment, and staffing due to previous US aid reductions. Studies estimate that funding interruptions last year led to more than 120,000 deaths, including over 13,000 child deaths, and further reductions could result in catastrophic health outcomes for those living with HIV.
Critics have condemned the approach as an attempt to exploit Zambia’s natural resources under the guise of foreign aid, with health advocates warning that leveraging essential medicine to extract economic concessions places millions of lives at risk. Civil society leaders in Zambia have called any additional cuts “apocalyptic” for the country’s HIV-positive population and overall public health.
