The deadline for Zambia to agree to the US’s terms that grants preferential rights over mineral supplies – including copper, cobalt and lithium, or risk losing HIV treatment funding for 1.3 million citizens lapsed on the last day in April 2026.
With an HIV epidemic in Zambia, with over 10% of the population infected, places the country among the worst in the world, and the fight against it has been dependant on US health aid for over 20 years.
The proposed arrangement reflects a broader shift in US foreign aid policy. Under the “America First” approach, the Trump Administration has moved away from traditional aid model to bilateral agreements that tie funding to strategic and economic interests.
In Zambia’s case, this includes reported demands for preferential access to critical minerals, mandatory healthcare expenditure and long-term data-sharing provisions.
Zambia has been a major beneficiary of US health assistance for decades, particularly through the President’s Emergency Plan for AIDS Relief (PEPFAR), which has supported antiretroviral treatment and helped reduce infections.
However, the restructuring of US aid since 2025 has disrupted this system. With the dismantling of the United States Agency for International Development (USAID) and funding cuts under Trump have forced Zambia to scale back key services. While most patients receiving treatment in early 2025 continue to access medication, about 100,000 people stopped treatment during the upheaval, with tens of thousands yet to return to care.
Health facilities that once provided comprehensive HIV services have been forced to cut back to basic treatment. Programmes such as contact tracing, community outreach, and early infant testing have been reduced or eliminated. Clinics have shifted from digital systems to paper records due to lack of funding, slowing down diagnosis and follow-up.
In parts of northern Zambia, clinicians report a rise in advanced HIV cases. In Mpongwe, a mission hospital recorded dozens of new cases in early 2026, compared to one or two per month previously. Health workers say patients are arriving late, often with severe complications linked to untreated infections.
Prevention efforts have also been weakened. Earlier systems that identified infections through contact tracing accounted for about 70% of detected cases, but these have been shut down. Testing has been restricted and community-based drug distribution networks have been dismantled. Vulnerable groups, including pregnant women, infants, and high-risk populations, have seen reduced access to specialised care.
Should Zambia agree to the proposed terms, It would receive around $1 billion in funding over five years – less than 50% of earlier amounts. This however comes at a price: $340 million in new health expenditure, strict performance targets, and long-term sharing of biological and health data.
One of the main contentions, which rights groups have decried as ‘exploitative’, is the linkage of health aid to mineral access.
Zambia is one of Africa’s largest copper producers and holds significant reserves of cobalt and other minerals critical to global supply chains. One of the main conditions laid down by the Trump Administration for continued aid is providing American businesses with first access to these resources.
Zambian officials have expressed reservations about the agreement, stating that some provisions do not align with national interests. Critics have argued that the deal further undermines public health and national sovereignty. Though the country has already increased domestic health contributions, it cannot rapidly replace the scale of US funding.
Modelling studies suggest that even short interruptions in HIV services could lead to tens of thousands of new infections and deaths. Longer disruptions could reverse decades of progress, significantly increasing HIV prevalence and mortality rates.
Zambia rejected the offer since February 2026, saying conditions set by Washington do not align with its national interests.