Washington Is Holding Zambia’s HIV Patients Hostage for Minerals.
OPINION:
Washington is threatening to withhold HIV treatment unless Zambia hands over access to its copper and cobalt. The terms are worse than anything offered to any other African country. But Zambia has more leverage than it thinks.
By Savior Mwambwa
Mr. Mwambwa works on economic sovereignty and development finance in the global majority countries. He is currently a Program Manager in the Economic & Climate Prosperity Team at the Open Society Foundations (OSF). Mr Mwambwa is former Executive Director at the Centre for Trade Policy and Development, a Zambian Think Tank.
March 2026
A State Department document seen by The New York Times confirmed what many of us tracking this issue have suspected for months. Washington is prepared to withhold HIV treatment funding from Zambia unless the government agrees to grant American companies preferential access to our copper, cobalt and lithium. The deadline is May 2026.
I want to be precise about what this means in practice, because the headline figure of $1 billion in health aid over five years clouds a set of conditions that are materially worse than anything the United States has negotiated with any of the other 24 African countries that have signed similar agreements.
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Let’s look at the numbers first. The United States committed $367 million to Zambia for HIV services alone in 2025. The proposed deal offers $320 million in total health funding for 2026, covering HIV, TB, malaria and disease surveillance combined. The overall five-year commitment of $1.012 billion is lower than the $1.5 billion the Zambian government announced in November 2025 after initial negotiations. Less money, harder conditions, tighter timelines.
In exchange, Zambia is required to contribute $400 million in domestic co-financing over five years, hire 40,000 new health workers, meet American-defined performance targets or face full termination of the agreement, share citizen health data with Washington for 10 years despite the funding covering only five, and commit to sharing information on any new or emerging pathogens within Zambia’s borders for 25 years with no benefit-sharing guarantee and no reciprocal data-sharing obligation from the United States.
For context: Kenya negotiated seven years on health data and is currently fighting that in court. No publicly available memorandum of understanding across the 24 signed agreements contains a 25-year pathogen provision. Zambia is being asked for something categorically different from what every other country was offered.
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The deeper issue is not the individual provisions. It is the architecture. This is the first time in the history of American global health diplomacy that PEPFAR funding has been made formally contingent on a minerals agreement. Veterans of American global health policy have described it publicly as a first of its kind for the State Department.
What this does structurally is convert humanitarian health assistance into a transactional instrument of resource extraction. Once that principle is accepted in the legal text, it does not stay bilateral. It becomes the template. Other partners, other minerals, other leverage points. The precedent is the problem, not just the terms.
There is also a fiscal trap embedded in the co-financing demands that deserves more attention than it is getting. Over a third of Zambia’s 2026 national budget is allocated to debt repayment. The $400 million co-financing requirement and the 40,000 health worker recruitment target are not stretch goals. They are, on current fiscal projections, unimplementable. Signing unimplementable commitments gives Washington contractual grounds to claim breach and return to the table with even more leverage. That is not a hypothetical risk. It is what is currently playing out in the Democratic Republic of Congo, where the Strategic Partnership Agreement signed under pressure in December 2025 is now being challenged in Kinshasa’s Constitutional Court.
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The framing of this negotiation as Zambia-the-dependent versus Washington-the-powerful misreads the structural reality of the global critical minerals market in 2026.
The green energy transition, electric vehicle manufacturing, semiconductor production and advanced defence technology all depend on copper and cobalt supply chains that run through the Central African Copperbelt. Zambia is Africa’s second-largest copper producer. The Lobito Corridor, the US EXIM Bank’s mineral financing strategy, the Orion Critical Mineral Consortium’s moves on Glencore’s Congolese assets and the entire architecture of the America First minerals strategy are premised on securing access to exactly what is underground in Zambia and the D.R.C.
The State Department document seen by The Times reflects frustration, not confidence. When a powerful counterparty resorts to threatening to cut HIV funding to extract mining concessions, it is because conventional commercial and diplomatic approaches have not delivered what they need. That frustration is Zambia’s leverage, not Zambia’s problem.
Zambia’s minerals will still be there in six months, a year, a decade. Washington’s urgency is driven by competition with China for supply chain dominance and by domestic political timetables that Zambia does not share. The longer Zambia stays at the table with a principled and unified position, the more that asymmetry of urgency works in its favour.
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I am not arguing Zambia should walk away. Zimbabwe walked away and PEPFAR wind-down began immediately. That is not a viable path when 1.3 million people are on daily treatment. The objective is a deal that is actually in Zambia’s interest, and the parameters of such a deal are clear.
Health funding should be restored to at minimum the levels committed in November 2025: $1.4 to $1.5 billion over five years. Co-financing should be capped at $250 million over five years, phased against an independent fiscal sustainability assessment. Data sharing should be capped at five years, co-terminus with the funding period. Pathogen sharing should be governed by the W.H.O. Pandemic Agreement’s benefit-sharing framework, not a bilateral clause drafted in Washington. Minerals access should be negotiated on competitive, non-exclusive terms that do not lock out China, the European Union, the Gulf states or African partners. Debt relief should be formalised as a parallel commitment, not a conditional reward that can be withdrawn mid-negotiation. And critically, the legal coupling of health and minerals should be decoupled in the text of both instruments.
None of these are unreasonable demands. Several are simply asking for parity with what other African countries were offered.
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Kenya signed first and is in court. Zimbabwe refused and lost its programme. The D.R.C. signed a minerals deal under a peace agreement and is in its Constitutional Court. Each path carries costs. What the regional picture tells us is that the fight does not end at signing. It either happens before, when leverage is highest, or after, when it is lowest.
Zambia has the opportunity to negotiate before. That window closes in May.
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PEPFAR has been one of the most consequential development interventions in Zambia’s modern history. When the programme began under President George W. Bush, 90,000 Zambians were dying of H.I.V. every year. That is not a number to move past quickly. The partnership that reduced it matters, and the people who built it on both sides deserve acknowledgment.
The argument for better terms is not anti-American. It is pro-partnership. Some of the sharpest criticism of the current approach has come from within Washington: from former PEPFAR architects, congressional Democrats and private-sector actors who understand that coercive resource extraction dressed as health aid will produce backlash that damages American interests in Africa for a generation.
A deal built on genuine mutual benefit, transparent terms and respect for Zambian sovereignty is also better for the United States than one that has to be contested in Zambia’s courts 18 months after signing.
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Zambia brings real assets to this negotiation: strategic mineral wealth, a stable democracy, a functioning health system, a track record of reform and a government navigating an extraordinarily difficult situation under significant external pressure.
The three things that must not be conceded are the legal coupling of health and minerals, the asymmetric data and specimen timelines, and the unimplementable fiscal commitments. Everything else is negotiable. If those three are protected, there is a deal to be had that serves both sides. If any of them are conceded under deadline pressure, the agreement signed in May will be in court by 2027.
Zambia has held difficult lines before. The debt restructuring process was not easy and it was not fast, but it produced a result the country could build on. This negotiation deserves the same discipline, the same patience and the same refusal to sign something unworkable just because the deadline feels urgent.
The minerals are for Zambians. And Zambia has The leverage, She should Use it.
