CONTENT WARNING: This opinion piece contains potentially triggering topics and language. Please use discretion when proceeding.
In his January 2003 State of the Union address, then-President George W. Bush said the prospect of war with Iraq was “very real,” among other things. These remarks, which preceded the catastrophic invasion of Iraq that would begin weeks later, overshadowed the announcement of a new Bush administration program called the President’s Emergency Plan for AIDS Relief (PEPFAR).
Few of those under the age of 30, including myself, can truly comprehend the HIV/AIDS-related trauma and fear that clouded American society from the early 80s up until the late 90s and arguably well into the 2000s.
Under the administrations of the 1980s and 1990s, the public health response to HIV/AIDS in the United States was frequently (and correctly) derided by advocates as callous, mishandled and bureaucratic. Furious advocacy groups such as ACT UP formed to find treatments, combat stigma and draw attention to the often-invisible victims of the epidemic such as LGBTQ+ communities, women and Black & Latino populations.
While around this time HIV/AIDS was still a tragic and unnecessarily deadly epidemic, things in the United States began to improve in the mid-1990s with the introduction of highly active antiretroviral therapy. The disease, which had killed roughly 450,000 Americans by the end of the year 2000, had changed from being stigmatized just by its associations with the gay community and intravenous drug users to a different sort of marginalization. By the time Bush announced PEPFAR in early 2003, HIV/AIDS was ravaging sub-Saharan Africa.
The numbers were staggering. According to the United Nations Programme on HIV/AIDS (UNAIDS), one in five adults in southern Africa were living with HIV/AIDS. In several countries, levels of AIDS-related mortality matched the rate of new infections.
According to UNAIDS an estimated 26.6 million people in this region were living with HIV in 2003. AIDS killed approximately 2.3 million people that year.
Every day in 2003 an estimated 14,000 people were newly infected with HIV. More than 95% of those live in low- and middle-income countries. Many of the same evils that drove the epidemic’s spread in the U.S. were only intensified amongst a population that was much larger, poorer and largely invisible to most of the world.
Since PEPFAR began, the program has saved 25 million lives and enabled 7.8 million babies to be born HIV-free. So, what all does the program do?
The program is authorized and funded by members of Congress, who themselves have faltered in their commitment to PEPFAR in recent years. It is then administered by the U.S. Department of State and the U.S. Agency for International Development, or USAID, which has essentially been gutted by Elon Musk and his crew of vigilante nerds at DOGE. The members of which were only just recently court-ordered to delete sensitive Treasury Department documents and systems that they had seized and stored on personal devices.
The work of PEPFAR is broad and far-reaching. In the fiscal year of 2024, its work supported:
- 6 million people on HIV meds;
- 5 million people newly enrolled on PrEP to prevent HIV;
- 8 million people tested for HIV;
- 3 million adolescent girls and young women reached with comprehensive HIV services;
- 6 million orphans, vulnerable children and their caregivers received critical care and support;
- 342,000 health workers directly supported by PEPFAR
On day one of his inauguration, President Trump issued an executive order requiring a pause on further obligations and disbursements of foreign assistance funds for 90 days. Elon Musk and DOGE have been “feeding USAID into the wood-chipper” and have fired all but 290 of the agencies’ over 14,000 federal employees, which will have devastating consequences across the world.
In relation to PEPFAR, care-providers in these places will be left without funding, guidance and authorization to carry out the functions of the program.
Trump and Musk have falsely claimed that USAID is a “vipers’ nest” of Marxism and called it a “criminal organization”. In reality, a sizeable chunk of USAID officers are required to undergo intense screening to obtain top-level clearances, and the agency is already audited by the actual government watchdog, the Government Accountability Office.
The real criminal element is Musk himself, who I bet would be less than eager to have his lofty contracts with the Department of Defense audited. A man whose net worth is more than that of the world’s global poor, probably a billion people, cutting the aid that gives the medicine and food to that global poor, is a textbook example of the gilded-age cronyism we find ourselves in.
If you’re wondering USAID’s budget was 0.3% of the federal budget in 2024. You could find more wasted money than that by just emptying out a filing cabinet in the Pentagon.
In response to the backlash to this decision, a waiver issued February 6 by the Department of State spelled out which PEPFAR services “should be resumed as soon as possible.” They include providing HIV testing, treatment and related care in addition to screening and treatment of cervical cancer and tuberculosis for people living with HIV.
Notably, however, they specifically mention that only pregnant and breastfeeding women are eligible for HIV prevention medication, known as PrEP (Pre-exposure prophylaxis). This cuts off coverage to millions of people at high-risk of HIV Infection such as young women and men who have sex with men.
The decision to selectively withhold PrEP from millions is reminiscent of the Reagan era indifference to HIV/AIDS related suffering in the LGBTQ community, making it official policy of the United States that only certain groups are deemed “worthy” of HIV prevention.
In a program of this size and scope, a 90-day “pause” is more like a permanent death sentence for millions living with the disease. Due to the pause in funding, UNAIDS projects that over 20 million people, including over 500,000 children under 15, will face a complete lack or disruption to care. There will be roughly 6.3 million more deaths, 8.7 million transmissions, services to 679,936 pregnant women with HIV would be halted, resulting in 135,987 babies acquiring HIV, and 1,471 new cases among infants for each day work is stopped.
Development experts note that until further clarification is given and authorization to restart contracts covered by the waiver is explicitly written, South Africa’s HIV clinics and other programs will continue to scramble for funds and continuity.
This kind of short-sighted, inhumane decision-making that leaves millions of lives in jeopardy unfortunately seems to be the new normal under Trump’s second administration. For the sake of millions, PEPFAR’s future needs to be secured.
