🇿🇲 EXPLAINER | Why The U.S. is Linking Zambia’s HIV Aid to Access to Critical Minerals
A new report by The New York Times has revealed that the United States is considering cutting major HIV and health assistance to Zambia if the country does not agree to a broader deal that would grant American companies greater access to Zambia’s mineral resources.
The report, written by global health journalist Stephanie Nolen, cites a draft memo prepared for U.S. Secretary of State Marco Rubio which outlines a strategy to pressure Zambia into signing a wider economic and strategic agreement.
According to the memo seen by the newspaper, American officials believe pressure may be necessary to secure their priorities.
“We will only secure our priorities by demonstrating willingness to publicly take support away from Zambia on a massive scale.”
The proposal has raised serious concern because Zambia is one of the largest recipients of the United States’ flagship HIV programme, the President’s Emergency Plan for AIDS Relief (PEPFAR).
For more than two decades, PEPFAR has funded HIV treatment programmes across Zambia. The New York Times reports that about 1.3 million Zambians currently depend on daily HIV medication supplied through the programme, alongside funding for tuberculosis and malaria treatment.
Health experts warn that any abrupt withdrawal of that support would place enormous pressure on Zambia’s health system.
A draft proposal seen by the newspaper suggests that the United States could provide about $1 billion in health funding over five years, but only if Zambia agrees to broader conditions tied to economic reforms and mineral access.
The agreement reportedly has three main components.
The first involves health financing, where Zambia would be expected to increase its own domestic spending on health services while continuing to receive American support through PEPFAR.
The second component focuses on Zambia’s mining sector, where the United States is seeking greater access for American companies to minerals such as copper, cobalt and lithium, which are crucial to global energy transition technologies.
These minerals are increasingly strategic as the world moves toward electric vehicles, battery storage and renewable energy systems.
The third component involves renegotiating a Millennium Challenge Corporation compact, which originally allocated $458 million to Zambia’s agricultural sector. Under the new proposal, Washington wants that agreement restructured to include regulatory reforms affecting mining and other industries.
The New York Times reports that Zambia would need to agree to all three elements by May in order to retain a portion of its current health aid.
The U.S. State Department has declined to comment on the leaked memo, stating it does not discuss internal diplomatic documents.
Meanwhile, the Zambian government has not yet issued an official response to the report.
The negotiations come at a sensitive moment for Zambia’s public health system. Although the country has made significant progress in HIV treatment coverage over the past two decades, new infections remain a growing concern, particularly among urban youth aged between 18 and 25.
Recent public health data shows that young people in urban areas continue to account for a significant share of new HIV transmissions, making the continuity of treatment and prevention programmes critically important.
The debate also echoes similar tensions elsewhere in Africa. Zimbabwe recently walked away from negotiations with the United States over comparable agreements, arguing that some of the proposed conditions — including provisions on data sharing and biological samples — could undermine national sovereignty.
In Zambia’s case, civil society groups have reportedly raised concerns about clauses in the draft agreement that would require the country to share health data for up to ten years and biological specimens collected during disease surveillance for up to 25 years.
The broader geopolitical context also matters. Zambia holds some of the largest copper reserves in the world and significant deposits of minerals essential for clean energy technologies.
For years, China has dominated investment in Zambia’s mining sector, and Washington has increasingly sought ways to expand Western participation in African mineral supply chains.
The negotiations therefore sit at the intersection of global health policy, economic diplomacy and strategic competition over critical minerals.
For Zambia, the central question will be how to balance public health needs, national sovereignty and economic opportunity as discussions with the United States continue.
For millions of Zambians living with HIV, however, the issue is far more immediate.
It is about whether the medicines they rely on every day will continue to be available.
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