Trump Moves to Kill PEPFAR, Potentially Dooming Millions to Death From AIDS

The U.S. program credited with saving an estimated 26 million lives and preventing millions of new HIV infections has not sufficiently provided a direct benefit to the United States, suggests Trump State Department planning documents for the George W. Bush-era initiative.

Congress rejected cuts to the President's Emergency Plan for AIDS Relief (PEPFAR) last week, even as Republicans pushed through nearly $8 billion in foreign aid cuts; the program has long had robust bipartisan support as it has enabled 5.5 million babies to be born without HIV to HIV-positive mothers, provided support to 7 million orphans, and driven a decline in new HIV infections in young women in every geographic area that implements its prevention program.

But as The New York Times reported Thursday, a draft plan at the State Department details proposals for "transitioning" low-income countries away from PEPFAR, with the Trump administration imposing what it calls "bilateral relationships" with the aim of ostensibly prioritizing public health in the United States.

Countries in the Global South would be asked to focus efforts on "the detection of outbreaks that could threaten the United States and the creation of new markets for American drugs and technologies," reported the Times.

The administration appears to be approaching PEPFAR with the logic, said journalist Ben Krauss, that the program "needs to be remade to exclusively serve American interests."

"Saving 25 million lives over the past two decades and pulling off one of the greatest humanitarian feats of the century was already serving American interests," said Krauss. "This is just evil."

The State Department documents also say the Trump administration believes "that the transition of PEPFAR can become the premier example of the U.S. commitment to prioritizing trade over aid, opportunity over dependency, and investment over assistance."

PEPFAR-funded programs in low-income countries have already struggled to stay afloat this year following President Donald Trump's foreign aid funding freeze soon after he took office in January. A stop-work order forced some programs to halt services like the provision of antiretroviral therapy and to lay off thousands of staffers.

A waiver issued in February allowed PEPFAR to continue certain programs, but the administration's cuts to and elimination of the U.S. Agency for International Development, which has implemented PEPFAR since its inception in 2003, has also impacted the initiative.

Under the plan outlined in the documents—which a spokesperson denied were "reflective of the State Department's policy on PEPFAR"—countries would be required to spend far more of their own funds on fighting the spread of HIV/AIDS. Countries that are close to controlling the epidemic, such as Vietnam and Botswana, would see an end to PEPFAR within two years, while countries that still have high rates of infection and receive significant amounts of U.S. funding, including Kenya and Zimbabwe, would have up to four years.

"There will be some countries that can manage where the PEPFAR investment is not as heavy or as large a proportion of their total effort," Robert Black, a professor at Johns Hopkins Bloomberg School of Public Health, told the Times. "But some of the African countries with enormous HIV problems and national financial problems, debt, and other development issues—I cannot see that they are going to be able to pick up all or even a large proportion of the costs in that kind of time frame."

Winnie Byanyima, the executive director of UNAIDS, the United Nations AIDS prevention agency, said earlier this month that the threats Trump has already made to AIDS relief programs across the globe have begun a "deadly funding crisis."

"Personally I am devastated," she said of the U.S. funding cuts at a U.N. summit in Seville, Spain. "Appalled. Shaken and disgusted. I don't have the English words to use."

Byanyima emphasized that HIV/AIDS prevention funding through PEPFAR and similar programs represents "a drop of money that is nothing in one of these rich G7 countries."

PEPFAR is funded through discretionary spending in the federal budget and accounts for less than .08% of U.S. spending.

"To create such crisis, such pain, and such anger on the ground," said Byanyima. "This cut, that's dedicated people losing jobs, loyal support gone, research ended, vulnerable people abandoned. And it is deaths. What went away immediately was prevention services, so we are very worried about the new infections and about deaths... There will be an additional 6 million newly infected persons in the world. That has started already."