PEPFAR Withdrawal & The Return of AIDS — Botswana’s Ministry of Health Reassures Citizens

Botswana’s Health Ministry has reassured citizens of the uninterrupted supply of life-saving antiretroviral drugs amid growing concerns over a potential resurgence of the HIV epidemic following the withdrawal of U.S. aid funding for AIDS programs across Africa.
At the height of the HIV/AIDS pandemic in Africa (late 1990s to early 2000s), 27 out of every 100 people in Botswana were infected, seconding Lesotho on list of hardest-hit countries.
George W. Bush Administration’s U.S. President Emergency Plan for AIDS Relief (PEPFAR), invested approximately $1 billion in health assistance to Botswana since its inception in 2003. While this expedited Botswana’s progress in reaching UNAIDS 95–95–95 targets, today the country still ranks top on 3rd in with a 22% prevalence rate, giving skeptics and anti-aid supporters alike, justification to question the results and impact of the two-decades long billion dollar program.
In an official statement issued on Wednesday 29 January 2025, the Permanent Secretary highlighted that the Botswana government’s ability to supply HIV treatment medication isn’t tied to PEPFAR, and reassured its role in overseeing its procurement and continued supply.
The Ministry further said abrupt withdrawal of foreign aid has resulted in the immediate cessation of U.S.-funded Civil Society Organizations (CSOs) health programs and initiatives such as life skills, psychosocial support, and community engagement to reduce HIV transmission among young people
While the Ministry recognizes the setback this presents for Botswana’s healthcare sector, the broader macroeconomic implications cannot be overlooked. The removal of $1 billion from circulation represents a significant contractionary shock, potentially disrupting aggregate demand, employment, and ancillary industries reliant on donor funding.
Weather President Trump’s executive order on aid is temporary or permanent, this development presents opportunity for social entrepreneurs to find solutions that reduce reliance on external aid, secure public health stability, and overall economic performance. Innovative solutions in health education, low-cost treatment distribution models, mobile health clinics, and public-private partnerships can emerge to address service disruptions.
Additionally, impact investors and social enterprises can play a crucial role in developing sustainable healthcare financing mechanisms, such as micro-insurance models and community-based health cooperatives, to build long-term resilience in HIV/AIDS response efforts.
This also necessitates urgent policy responses by lawmakers to mitigate adverse spillover effects, including strengthening domestic healthcare financing, fostering public-private partnerships, and exploring alternative funding mechanisms such as social impact bonds and regional health collaborations.