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'Things Are Not Okay': US Threatens to Withhold HIV Funding Unless Zambia Allows Plunder of Its Minerals
"The State Department is threatening Zambia with an embargo on essential medicines in order to plunder its minerals," said one HIV prevention advocate.
Mar 17, 2026
The US State Department is threatening to strip HIV/AIDS and other disease prevention funds for more than a million people in the African nation of Zambia in a bid to extort the country for greater access to its mineral wealth.
The New York Times reported Monday on the draft of a memo prepared for Secretary of State Marco Rubio, which states that "we will only secure our priorities by demonstrating willingness to publicly take support away from Zambia on a massive scale."
The Trump administration is considering whether to "significantly cut assistance" from the President’s Emergency Plan for AIDS Relief (PEPFAR), which provides daily HIV treatment to around 1.3 million Zambians and other funds for tuberculosis and malaria medications that save tens of thousands of lives each year.
At the time that PEPFAR was created, under the administration of President George W. Bush, HIV was killing around 90,000 people per year in Zambia. That number had been reduced to 16,000 in 2024, according to data from the Joint United Nations Program on HIV/AIDS (UNAIDS).
"Things are not okay," said Justin Wolfers, an economics professor at the University of Michigan and a Brookings Institution fellow.
Threats to cut PEPFAR are part of a broader push by the Trump administration to wield desperately needed foreign medical aid as a tool of coercion against impoverished nations, whose health systems have been thrown into turmoil by the Trump administration's massive cuts to the US Agency for International Development (USAID) last year.
According to the Times, 24 African nations have signed memoranda of understanding (MOU) under the Trump administration's so-called "America First Global Health Strategy" in order to unlock some US funding that has been cut.
Many of the deals require nations to increase their own health spending in order to restore just a fraction of what the US previously provided:
"According to an analysis by the nonprofit Partners in Health, health funding under the agreements would drop by 69% to Rwanda, 61% to Madagascar, 42% to Liberia, and 34% to Eswatini, where a quarter of adults live with HIV," the Times reported in January.
Meanwhile, the deals have come with other, often ideological, strings attached. Kenya's memorandum requires it to provide data guaranteeing that no funding is being used for abortion care, and to direct funds to certain Christian faith-based providers, even though they refuse services like HIV care to LGBTQ+ people.
Nigeria's agreement likewise requires more than $200 million to over 900 Christian faith-based healthcare facilities across the country and emphasizes protecting Christian victims of violence from the Islamist group Boko Haram, even though the majority of the group's victims are Muslim.
Some countries have rejected the deals, calling them one-sided and exploitative. Last month, Zimbabwe walked away from a deal that would have provided $367 million over five years because it required the country to give the US unfettered access to citizens' health data and biological samples.
The deal offered to Zambia is similar to those offered to other countries in that it requires the government to commit $340 million in health spending in exchange for $1 billion from the US over five years, less than half of what it received under previous US administrations. It also demands that Zambia provide citizens' health data to the US for 10 years, longer than the deals agreed to by other nations.
But the deal also stipulates that, to receive any funding, Zambia must provide US corporations with easier access to the nation's vast mineral wealth.
Zambia has some of the world's largest reserves of minerals such as copper, lithium, and cobalt, which are essential to green energy technology. The Trump administration says the country has given China greater access to its mines than it has given to the US.
Zambia would also be required to share mining databases with US experts and renegotiate a massive 2024 contract with the Millennium Challenge Corporation, a US-based foreign assistance agency, to reduce mining regulations.
After the terms of the deal leaked to The Guardian last month, Asia Russell, director of the HIV advocacy organisation Health GAP, derided it as a proposal for the "shameless exploitation" of Zambia.
In February, Zambia rejected the deal, with a spokesperson for the Ministry of Health saying it "did not align with the position and interests of Zambia."
Now the Trump administration is using HIV treatment funding in an effort to force its leaders back to the table and make an example of them for other countries that may seek to go their own way.
The memo describes threats to AIDS funding as a way to demonstrate the "use of sticks" to other countries with which it seeks to negotiate.
If Zambia refuses to sign, it says, “sharp public cuts to American foreign assistance would significantly demonstrate to aid-receiving countries the seriousness of our interest in collaboration and our insistence on tangible benefits under our America First foreign policy."
Zambia has already been stripped of more than half its annual PEPFAR funding from the US since the Trump administration returned to power last year through a combination of foreign aid freezes, rescissions, and budget cuts that stripped billions from the program.
A survey of 76 HIV clinics across 32 mostly African countries that received PEPFAR funds, conducted by the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium, found that, as a result of cuts, many experienced disruptions to testing and treatment, including drug shortages and staff layoffs.
Citing modeling studies, the researchers estimated that funding disruptions to PEPFAR just last year "resulted in more than 120,000 deaths by November 2025, including more than 13,000 child deaths."
Another study by Imperial College London predicted that just the three-month disruption at the beginning of President Donald Trump's second term would result in more than 37,400 excess deaths by 2060.
In a statement posted to social media on Monday, Republicans on the House Foreign Affairs Committee defended the threats to cut PEPFAR, saying that "Just like every other country, Zambia is free to walk away from these negotiations." The REpublicans said it was "ridiculous to assume the United States should fund entire health systems for countries that turn around and give priority access to critical supply chains to China."
Russell said that "the State Department is threatening Zambia with an embargo on essential medicines in order to plunder its minerals."
While she said "Zambia’s MOU text is the first we know of that explicitly ties exploitation of mineral wealth," she noted that similar "exploitative conditions" are reportedly part of other nations' memoranda as well, but that information is scarce because they have been "negotiated in secret" and texts have not been made public.
Julius Kachidza, the chair of Zambia’s Civil Society Self-Coordinating Mechanism, said that yet another massive cut in US government funding “would be apocalyptic. It could be quite a disaster, especially to me. And the majority of people living with HIV in Zambia.”
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All UN Security Council Members Except US Join Somalia in Condemning Israel's Recognition of Somaliland
Somalia's UN ambassador said Israel plans to “relocate the Palestinian population from Gaza to the northwestern region of Somalia," and warned that "this utter disdain for law and morality must be stopped now."
Dec 30, 2025
At an emergency meeting of the United Nations Security Council on Monday regarding Israel's recognition of the breakaway region of Somaliland, 14 of 15 member states joined Somalia's permanent representative to the UN in condemning what the ambassador called an “act of aggression"—and at least one denounced the Trump administration's defense of Israel's move.
The emergency summit was called days after Israel announced its formal recognition of the region, which declared independence in 1991 after a civil war, but which has not been acknowledged by any other country. Somalia continues to claim Somaliland as part of the country while the region's leaders say the state is the successor to the former British protectorate.
Israel announced its decision months after Prime Minister Benjamin Netanyahu spoke with leaders in Somaliland about a potential deal to trade formal recognition of the region for help with illegally deporting Palestinians from Gaza, and as Israeli policy advisers have argued that Somaliland could be used as a base for military operations against the Houthis in Yemen.
Despite evidence that Israel formally acknowledged Somaliland to further its own military and territorial interests, Israeli Deputy Permanent Representative Jonathan Miller arrived at the meeting Monday with the aim of explaining the "historical context" for the country's decision.
"Entire cities were destroyed," said Miller. "Civilians were deliberately targeted. These crimes are now widely recognized as a genocide... Israel's then-acting permanent representative, Yohanan Bein, submitted this letter to this very council warning of grave human rights violations in Somalia... That history provides essential context for the discussion surrounding Israel's recognition of Somaliland today."
Abukar Dahir Osman, Somalia's permanent representative to the UN, suggested Miller's comments only added insult to injury, considering Israel has been assaulting Gaza for more than two years—with attacks continuing despite a "ceasefire"—and has killed more than 71,000 Palestinians in what numerous human rights groups and experts have called a genocide.
"If we want to talk about genocide, it's Israel that's committed this to our own eyes every day," said Osman. "[Miller] represents a government that killed more than 70,000 people. Civilians, including children, women, elderly, doctors and other health workers, and patients in hospitals. Destroying infrastructures, deliberately starving people of Gaza."
“To come to this place, and lecture us [on] humanity and genocide and human rights and independence and democracy. And we know what you’re doing on a daily basis," said Osman. "It’s just an insult.”
Somalia’s representative at the United Nations had a history lesson to share with Israel’s envoy today. “To come to this place, and lecture us [on] humanity & genocide & human rights & independence & democracy. And we know what you’re doing on a daily basis. It’s just an insult.” pic.twitter.com/dcg3NnGKI4
— Drop Site (@DropSiteNews) December 30, 2025
Warning that the recognition of the breakaway region could destabilize Somalia as well as the broader Horn of Africa, the ambassador also expressed concern that Israel plans to “relocate the Palestinian population from Gaza to the northwestern region of Somalia."
"This utter disdain for law and morality must be stopped now,” said Osman.
Other representatives expressed similar outrage, with the UN envoy for the 22-member Arab League, Maged Abdelfattah Abdelaziz, saying the group would reject “any measures arising from this illegitimate recognition aimed at facilitating forced displacement of the Palestinian people, or exploiting northern Somali ports to establish military bases."
Muhammad Usman Iqbal Jadoon, deputy UN ambassador for Pakistan, said Israel's move following its previous comments on potentially deporting Palestinians to Somaliland was "deeply troubling."
Tammy Bruce, who was sworn in Monday as deputy US representative to the United Nations, was alone in backing Israel's recognition of Somaliland, though she noted that US policy on the region has not changed.
"Israel has the same right to conduct diplomatic relations as any other sovereign state," said Bruce. "Earlier this year, several countries, including members of this council, made the unilateral decision to recognize a nonexistent Palestinian state. And yet, no emergency meeting was called to express this council’s outrage."
More than 150 countries, including a number of major US allies, have recognized Palestinian statehood, with nearly two dozen governments announcing their recognition since Israel began its assault on Gaza in 2023.
Samuel Zbogar, Slovenia's UN ambassador, pushed back against Bruce's comparison.
"Slovenia recognized Palestine as an independent state," he said. "We did so in response to undeniable right of Palestinian people to self-determination. Palestine is not part of any state. It is an illegally occupied territory as declared by the [International Court of Justice], among others. Palestine is also an observer state in this organization."
"Somaliland, on the other hand, is part of a UN member state and recognizing it goes against Article 2, paragraph 4 of the UN Charter," he said.
On Tuesday, protests erupted in cities across Somalia, including the capital of Mogadishu, with demonstrators calling for national unity.
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Families Demand Justice After US Admits Drone Strikes Killed Somali Civilians
"AFRICOM's perfunctory acknowledgment and empty condolences are not just underwhelming, they are a profound injustice," said the rights group Hūmānus, which represents two families of victims.
Sep 23, 2025
As the US has ramped up drone strikes in Somalia since President Donald Trump's return to power in January, the military has also confessed to some civilian deaths resulting from attacks conducted during his first term—but victims' families are demanding more.
Al Jazeera on Tuesday published interviews with two impacted family members. Abubakar Dahir Mohamed's 22-year-old sister, Luul Dahir Mohamed, and 4-year-old niece, Mariam, were killed on April 1, 2018. She left behind a son who is now 13.
The pair was traveling in a pickup truck with other passengers to a town where another brother lived. US Africa Command (AFRICOM) initially said it struck "five terrorists" and destroyed one vehicle, but later admitted an unnamed "mother and child" were killed.
As Al Jazeera detailed:
That day, according to media reports and Luul's family, US drones bombed the pickup truck. Immediately after, locals found several bodies in and around the site. Further down the road, about 60 metres (200 feet) away, was the lifeless body of Luul, clutching onto her child, whose small body was covered in shrapnel.
"When they fired on the vehicle, Luul made it out with her daughter. They knew it was a woman and child, and then they fired once again, killing them both in the second strike," Abubakar said from the Somali capital, Mogadishu.
"The Americans claim to uphold human rights, but apparently, when it comes to people like my sister and niece, their lives don't matter."
The outlet also spoke with Mohamed Osman Abdi—whose 17-year-old niece, Nuro Kusow Omar, was killed in a February 2, 2020 strike that also injured another niece and his mother-in-law—and reported on letters that AFRICOM recently sent to Hūmānus, a nongovernmental organization representing both families.
Under "current Department of Defense guidelines and policies, US Africa Command determined it is not feasible to make a condolence payment in this matter," AFRICOM claimed in both letters.
In an email to Al Jazeera, AFRICOM said it assessed "mission objectives, cultural norms, local economic realities" as well as "the feasibility, safety, security, and logistics of making the payment itself," and made the decision based on the risk that the money could be "subject to confiscation, extortion, or unofficial taxation by terrorist or hostile insurgent groups."
Osman Abdi said that "it's a cheap excuse. They killed and maimed these people. Using fears of the money being extorted or confiscated is another way of saying the lives [lost] are worth nothing."
"It's painful and shows how desperate they are to rid themselves of any accountability," he added.
In a statement shared on the networking platform LinkedIn, Hūmānus also called out the United States. AFRICOM confirmed civilian harm from the strikes "after years of grueling advocacy," the group said. "This is a victory, yes, but a hollow one. It is a testament to the bravery of our clients and the tireless work of our team, tainted by the very system we were forced to navigate."
"AFRICOM's perfunctory acknowledgment and empty condolences are not just underwhelming, they are a profound injustice. Our clients have already navigated a long and arduous process exhausting every available channel, only to be met with a system designed to look the other way," Hūmānus continued. "The irony is palpable: While the US Congress has earmarked funds for ex gratia payments, these families—who deserve peace and closure—have been met with nothing but institutional indifference."
"This refusal to provide reparations compounds their trauma and sends a deeply troubling message to other victims and survivors around the world," the group added. "Reparations are not just about money; they are a formal recognition of the harm and a vital, final step toward a full stop for survivors. When this crucial component is absent, the so-called 'accountability process' reveals itself as little more than an elaborate exercise in futility."
According to the think tank New America, the US has conducted 410 strikes in Somalia since the George W. Bush administration, killing at least dozens of civilians. Most have occurred under Trump: 219 during his first term and 80 this year.
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