More than one million people are living with HIV in Zambia, one of several African countries where the United States President’s Emergency Plan for AIDS Relief (PEPFAR) program has been a cornerstone of funding life-saving medical treatments for more than two decades.
During this time, Zambia has made significant progress in fighting the disease, according to the United Nations, with new HIV infections falling from 63,000 to 30,000 between 2010 and 2025. But the southern African nation is reportedly reluctant to sign a new deal with the US, linking this vital lifeline to demands for greater access to its vital minerals.
At the end of March, the new York Times informed It had obtained a memo prepared for Secretary of State Marco Rubio detailing how the US could “massively” withdraw health aid to force Zambia and other countries to accept US conditions.
From aid distribution to bilateral agreements
After dismantling USAID, the world’s largest foreign aid agency, last year, the Trump administration has sought to replace decades of aid with new bilateral deals, called memoranda of understanding (MOUs), as part of its America First global health strategy.
In a written statement to DW, the US State Department said it wants to partner “with select countries” to “shift from a foreign aid paradigm to an investment and development paradigm.”
Details of many are unknown, but the State Department said the MOUs represent more than $20.6 billion (€17.6 billion) in new health funding to fight HIV/AIDS, malaria, tuberculosis and other infectious diseases. across Africa, So far 23 countries have signed bilateral agreements with the US.
But two countries are holding back: Zimbabwe and Zambia.
“[The Trump administration is] “This is a fundamentally different approach than the U.S. government has used in the past,” said Conor Savoy, visiting fellow at the Center for Global Development and formerly head of foreign policy engagement at USAID.
America pressures African countries to accept health agreements
Zimbabwe has walked away from the talks, calling US demands on data and biological samples “disproportionate” and an “intolerable infringement on sovereignty”.
The Government of Kenya accepted a deal. However, activists with similar data privacy concerns have taken it to court.
America has been trying to reach an agreement with Zambia for several months. In February, its government said the US proposal was not in line with the country’s interests. The US is proposing $1 billion in health funding over five years, less than half the amount Zambia received before Trump took office.
Zambia also must commit $340 million in new health spending, and the US has demanded 25 years of biological and sample data. It reportedly has until May to sign or lose funding.
Zambia has already increased its own health contributions, including to some HIV programs. However, according to Savoy, increasing health spending cannot happen overnight.
“Their system is not in a place where they can take on the full challenge of health funding,” he told DW.
Another reported demand from the US is access to Zambia’s vital minerals. The country has significant reserves of nickel and cobalt and is one of the world’s largest copper producers.
Earlier this year, the Trump administration launched Project Vault aimed at countering China’s dominance in rare earth minerals. But reports of health aid being traded for minerals are a matter of concern to experts.
“Ultimately we are playing with fire here and this could further erode confidence, credibility and our credibility on the continent,” Savoy said.
healthgap, A health advocacy organization working in Zambia reported that activists are “demanding to reject funding deals conditioned on access to mining.”
Which countries have agreed to US mineral deals?
Many African countries have already signed MoUs with the US. “There are countries that want these types of investments, and they will be open to them,” Savoy said.
It is difficult to confirm whether critical minerals have remained intact in other deals. For example, the Democratic Republic of the Congo has signed a health agreement and a separate minerals agreement with the US.
Some countries may welcome a mineral deal with the US.
“Many countries in the region have tried to diversify away from China,” Savoy said. But he discussed keeping health and economic deals with the US separate.
“This effort, particularly in Zambia, could seriously undermine our credibility. At the end of the day we are essentially doing what the US government has accused China of doing in Africa for the last two decades.”
Concerns rise for Zambia’s HIV patients
If no deal can be reached and the US “massively” reduces its financial assistance, the impact could be felt immediately.
Oxfam recently warned These deals are “effectively putting the health and well-being of thousands of people at risk by turning humanitarian aid into a bargain.”
For 1.3 million Zambians it could mean losing daily life-saving HIV treatment, which had helped reduce AIDS-related deaths in the country by more than 70% over the past 15 years.
Zambia’s Ministry of Health was contacted for this article but did not respond at the time of publication.
Edited by: Cai Nebe