Zambia: Is the US trading HIV treatment for minerals?

Lead

LUSAKA — Zambia, home to more than a million people living with HIV, is pushing back against a proposed US aid agreement that critics say would trade life-saving treatment for access to the country's critical minerals. The standoff highlights a broader shift in US foreign policy under the Trump administration, which replaced decades of aid with bilateral deals that tie health funding to data access and strategic resources.

According to the United Nations, new HIV infections in Zambia dropped from 63,000 in 2010 to 30,000 in 2025, progress largely credited to the US President's Emergency Plan for AIDS Relief (PEPFAR). Now, Zambia is reportedly reluctant to sign a new Memorandum of Understanding (MOU) with the US, which would continue that support in exchange for mineral access, as reported by Deutsche Welle and Al Jazeera.

Coverage Comparison

Reporting from Al Jazeera and Deutsche Welle largely converges on the core facts: the US suspended global health aid in 2025, replaced it with bilateral MOUs, and Zambia and Zimbabwe have resisted the terms. Both outlets describe US demands for health data and critical minerals as a significant departure from past practice.

Al Jazeera, with a critical tone, quotes experts describing the deals as "exploitation" and notes that "700,000 more deaths, mostly of children, each year" are expected as a result of the aid suspension — a figure attributed to experts, though not independently verified.

Deutsche Welle, similarly critical, adds that a memo prepared for Secretary of State Marco Rubio, obtained by The New York Times, outlined how the US could withdraw health support "on a massive scale" to force compliance. DW notes that 23 African countries have signed MOUs representing over $20.6 billion in new health funding, according to the US State Department.

The South China Morning Post, meanwhile, reports from a different angle, focusing on China's growing health and food aid to Africa, including a $3.49 million grant to South Africa for HIV prevention. That report does not mention the Zambia dispute directly.

Key Claims

• US suspended global health aid in 2025, which experts say could lead to an additional 700,000 deaths annually, mostly children, according to Al Jazeera.
• The US has proposed bilateral health agreements to developing countries, including demands for sensitive health data and critical minerals, as reported by both Al Jazeera and Deutsche Welle.
• Zimbabwe and Zambia have resisted: Zimbabwe reportedly walked away from negotiations over a proposed $300 million deal in November, while Zambia called US clauses "problematic" and requested a review in early March, per Al Jazeera.
• 23 African countries have signed MOUs with the US, totaling over $20.6 billion in new health funding, according to the US State Department, as cited by Deutsche Welle.
• China is expanding health aid in Africa, including a grant to South Africa for HIV prevention and drought-relief aid to several countries, as reported by the South China Morning Post.

Perspectives

US officials frame the new MOUs as a transition from "foreign assistance paradigm to an investment and growth paradigm," as stated by the US State Department in a written statement to Deutsche Welle. They say the deals are meant to make aid more sustainable.

African governments such as Zambia and Zimbabwe, however, view the demands as problematic and disproportionate. Al Jazeera quotes officials saying the proposals seek access to minerals and health data in ways never before demanded.

Health experts express concern that tying aid to resources could undermine humanitarian principles and create dependencies. Sarang Shidore, Africa director at the Quincy Institute, told Al Jazeera that "supporting global health has clear benefits to the United States" in preventing pandemics that could affect Americans, suggesting that tying aid to resource access may be counterproductive.

China's role is also noteworthy: as US aid contracts, Beijing is stepping in with grants and food aid, according to the South China Morning Post, potentially shifting the geopolitical balance in African health diplomacy.

The situation in Zambia remains fluid, with negotiations ongoing and the fate of HIV treatment for 1.3 million people hanging in the balance, according to Deutsche Welle.