The United States has ended its global health funding to Zimbabwe following the country’s rejection of a proposed "America First" foreign aid agreement, marking a significant shift in U.S. health assistance policy. The announcement, confirmed by the State Department on Wednesday, affects programs targeting HIV and other infectious diseases that have been heavily supported by U.S. aid.

Under the Trump administration, efforts to reshape America’s foreign aid strategy have included dismantling the U.S. Agency for International Development (USAID) and negotiating bilateral health deals directly with partner countries. The administration has said these agreements are intended to foster stronger, self-sufficient health systems and reduce dependency on external funding. According to the State Department, deals were signed with 35 countries; however, some nations, including Zimbabwe, declined to accept the terms.

Zimbabwean negotiations stalled late last year after officials expressed concerns that the proposed agreement undermined national sovereignty, with particular resistance to a clause requiring the sharing of health data with the U.S. Similar privacy issues led Kenya to legally challenge the agreement, halting its implementation.

Zimbabwe has been dependent on U.S. support for over 40 percent of its HIV-related health spending, largely through the President’s Emergency Plan for AIDS Relief (PEPFAR) and other programs. Approximately 1.3 million Zimbabweans live with HIV, with an estimated 10 percent adult prevalence rate. Health advocates warn that the withdrawal of U.S. aid could have severe public health consequences. Asia Russell, executive director of Health GAP, an international HIV advocacy group, described the development as potentially disastrous, evoking concerns of a regression to a period marked by widespread AIDS-related fatalities.

In response, Zimbabwean authorities have pledged to increase domestic health spending and seek additional support from international organizations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Zimbabwean government has also conveyed assurances to the U.S. that it can manage care for its population despite the loss of funding, according to the State Department.

The decision has elicited varied reactions within Zimbabwe. Former minister Jameson Timba, now a government critic, acknowledged the country’s right to reject the U.S. offer but urged transparency from the government about its alternative plans to support those reliant on U.S.-backed programs. Meanwhile, community health leaders report widespread uncertainty and concern among health workers who must now adapt to funding cuts and a shifting operational landscape.

Several other African countries, including Ghana, Zambia, and Namibia, have also declined or delayed signing similar health agreements with the U.S. South Africa, which has the highest number of people living with HIV globally, was not offered a deal due to ongoing diplomatic tensions with the Trump administration.

Zimbabwe’s economic challenges—including hyperinflation, debt, and limited access to capital—compound the risks associated with the loss of U.S. health aid, especially under President Emmerson Mnangagwa’s government, which has faced criticism for authoritarian governance since taking power in 2017. Mnangagwa succeeded Robert Mugabe following a military intervention after decades of Mugabe’s dominance since Zimbabwe’s independence in 1980.