The State Department is requiring African countries to grant access to health data on millions of people as a condition for receiving billions in US aid for HIV, malaria, and TB programs. The US says the data will be aggregated and de-identified, but privacy advocates and governments worry this establishes a precedent where health surveillance becomes a lever for geopolitical leverage and corporate access. At least seven African countries have signed such agreements under the Trump administration's health strategy, raising sovereignty concerns about how this data could ultimately be used or shared.