The United States is considering cutting critical health funding to Zambia, including HIV treatment support, as leverage to secure a deal granting American companies greater access to the country's vast mineral resources, according to a policy memo obtained by The New York Times.

The proposal, currently under discussion within the State Department, aims to pressure Lusaka into signing a broader agreement that would open its mining sector to US firms. This potential shift in aid strategy places at risk the approximately 1.3 million Zambians who depend on daily HIV treatment funded by the US government's long-standing PEPFAR program, as well as critical support for tuberculosis and malaria interventions. The memo warns that aid cuts could begin as early as May if negotiations stall.

The tense talks are part of a wider US strategy to reshape foreign aid under an "America First" policy, increasingly tying funding to direct strategic and economic interests. Across Africa, the US has been negotiating multi-year health compacts worth billions, which require recipient countries to boost domestic health spending and meet specific conditions.

However, Zambia's case has emerged as one of the most contentious. Unlike other agreements focused primarily on health, the proposed deal links funding to sweeping mining sector reforms and access to key resources—including copper, cobalt, and lithium—that are critical to global clean energy supply chains.

Zambia has pushed back on several provisions in recent weeks, arguing they do not align with its national interests. Major sticking points include clauses related to long-term data sharing and broader concerns over national sovereignty. The draft framework proposes sharing health data for up to 10 years and biological samples for as long as 25 years, raising alarms among civil society groups about privacy, data ownership, and the long-term benefits for Zambia.

Activists have also warned that tying health funding to a separate minerals agreement could prioritize commercial interests over public health, setting a dangerous precedent.

Similar concerns have emerged elsewhere on the continent. Zimbabwe recently walked away from comparable negotiations, and legal challenges have been filed in Kenya over analogous data-sharing provisions.

The proposed aid package for Zambia is estimated at roughly $1 billion over five years—a significant reduction from previous levels of US health support—even as the country remains heavily reliant on donor funding for its critical programs.

The standoff reflects a broader geopolitical contest for influence over Africa's natural resources. Zambia, one of the world's top copper producers with growing reserves of cobalt and lithium, has become a key battleground in the competition between the United States and China for minerals essential to electric vehicles and renewable energy technologies.

Talks between Washington and Lusaka, which have dragged on since late 2025, have reportedly seen US officials intensify pressure through both diplomatic and financial channels. Zambia, for its part, faces a delicate balancing act: managing a heavy debt burden and dependence on foreign aid while seeking to retain control over its resource wealth.

The outcome of the negotiations will not only shape the future of Zambia's health sector but could also set a precedent for how major powers link humanitarian assistance to strategic economic interests across the African continent.