Donald Trump and Marco Rubio turned off PEPFAR, an anti-AIDS program that saved millions of lives
For National Black HIV/AIDS Awareness Day: ACT UP, fight Trump, fight AIDS.
On January 20 Donald Trump issued an executive order that “disbursements of development assistance funds” for “foreign countries” be “immediately pause[d]”, pending “reviews” of such foreign aid for “efficiency and consistency with United States foreign policy”. Four days after that, Trump’s Secretary of State Marco Rubio put Trump’s order into action by approving a memo that barred the US government from “provid[ing] foreign assistance funded by or through the [State] Department and USAID without the Secretary of State’s authorization”, later confirmed by a press release bragging that “Rubio has paused all U.S. foreign assistance funded by or through the State Department and U.S. Agency for International Development (USAID)”.
This funding freeze halted much American foreign-aid spending, including spending on PEPFAR, the President’s Emergency Plan for AIDS Relief.
George W Bush initiated PEPFAR in 2003 to fund HIV/AIDS treatment, prevention, and research, and PEPFAR became “the largest global health program focused on a single disease in history until the COVID-19 pandemic”. Underrated by economists at the time, PEPFAR has been a massive success, particularly in sub-Saharan Africa. According to the World Health Organization, PEPFAR has saved about 26 milion lives, and it currently treats more than 20 million people living with HIV, “including 566 000 children under 15 years of age”. Most recently, PEPFAR and its partners had “been working on sustainability plans” to reduce PEPFAR’s dependence on donors “up to and beyond 2030”, but the US’s abrupt plug-pulling has disrupted this work to make PEPFAR less dependent on American money — ironic given the supposed “efficiency” rationale for the funding halt.
Because PEPFAR was actively supplying millions with HIV/AIDS medication, the Trump-Rubio halt to its funding is going to lead to people getting infected with HIV, people with HIV developing AIDS, and people dying of AIDS. That’s presumably why, four more days after putting Trump’s order into action, Rubio made a show of carving out an exemption; Rubio “issued a waiver” “for life-saving humanitarian assistance during [the] 90-day pause in foreign aid”.
But the waiver is just ass-covering. It doesn’t reverse the damage of the original orders.
Even with the waiver, “there is a lot of confusion on the ground [in Africa and other countries where PEPFAR actually doles out its life-saving drugs] especially at the community level on how the waiver will be implemented”, according to UNAIDS’s Deputy Executive Director, Christine Stegling. Development researcher Charles Kenny mentions news reports indicating that Rubio’s waiver has left clinics shuttered and assistance paused, because the waiver’s “vague”, “a fig leaf”. Matt Sledge reports in The Intercept reports that Rubio’s original memo threw contractors implementing PEPFAR out of work, that it took Rubio over a week to grant PEPFAR a specific waiver, and that the specific waiver is so narrow that it “has left America’s foreign partners piecing through what they can and cannot do with U.S. dollars and drugs”, leaving “HIV clinics in South Africa, where PEPFAR helps provide daily treatment to 5.5 million people, […] closed days after the waiver was announced”. And, from Apoorva Mandavilli in The New York Times:
Two weeks into President Trump’s sweeping freeze on foreign aid, H.I.V. groups abroad have not received any funding, jeopardizing the health of more than 20 million people, including 500,000 children. Subsequent waivers from the State Department have clarified that the work can continue, but the funds and legal paperwork to do so are still missing.
With the near closure of the American aid agency known as U.S.A.I.D. and its recall of officers posted abroad, there is little hope that the situation will resolve quickly, experts warned.
Worse, even if Trump and Rubio properly restore funding to PEPFAR for now, they’ve put it in jeopardy by turning it into a partisan hostage ahead of PEPFAR’s Congressional authorization expiring on March 25, just 6 weeks from now. Clinical trials — PEPFAR funds research as well, remember? — which can’t be arbitrarily stopped and started on a whim, have been frozen by the aid pause. One research team was faced with the dilemma of leaving experimental silicone rings installed in the vaginas of South African women, or violating the Trump-Rubio diktat by helping the women remove the rings.
Fight back: defend PEPFAR
Queer people recognized the threat of Donald Trump very early; ACT UP New York protested outside Trump Tower on Halloween of 1989. Their protests of Trump, along with those of other LGBTQ and public-health organizations, have continued to this day. Thousands of people just protested outside the State Department’s Washington, DC headquarters, a protest organized with the help of ACT UP NY, Treatment Action Group, Health Gap, and Housing Works. Some protesters blocked Constitution Avenue. Others chanted, “Lift the freeze on PEPFAR!” and “Trump has blood on his hands!”. An older activist recalled attending “over 15 memorial services for friends who had died of AIDS” in the summer of 1989.
If you live near New York City, a rally’s happening at 1PM on Union Square to stand in solidarity with transgender youth and demand that New York hospitals not break state law by depriving youth trans people of healthcare.
Wherever you live in the US, you might sign PrEP4All’s petition demanding that Congress not inflict $700 million in proposed cuts to anti-HIV funding. You might also call the Capitol switchboard at (202) 224-3121 and demand that your representatives
demand restoration and maintenance of PEPFAR’s funding in full,
speak out for foreign health aid more generally,
move to impeach Donald Trump, whose shutdown of USAID is unconstitutional and illegal (and who advocates for the unlawful ethnic cleansing of Gaza), and
physically force their way into USAID’s HQ if they’ve got the guts.
If you want an online guide to outline the process of calling, you can consult 5 Calls.
Yes, USAID is spooky as hell, but
USAID did not just administer PEPFAR. It’s engaged in covert operations and attempts at regime change, and worked with the CIA. After USAID was busted funding ZunZuneo, a failed ripoff of Twitter, to try to capture an online audience of Cubans and sow unrest against Cuba’s government, Foreign Policy editorial fellow Catherine A. Traywick and eXiled/Pando Daily reporter Mark Ames both wrote articles summarizing USAID’s history of foreign subversion and cooperation with the CIA’s so-called “Office of Public Safety”, teaching torture to police working for authoritarian regimes.
So one possible reaction to Trump and Rubio’s funding freeze for USAID is to shrug, or even cheer, and declare that USAID had it coming. Another would be to giggle at potential USAID-funded online socketpuppets losing their meal ticket.
Understandable reactions, but ultimately, I’ve seen no firm evidence of any regime-change attempts or torture training being halted by the Trump-Rubio orders, while I see plenty of testimony to their orders having interrupted PEPFAR’s lifesaving operations. Ames himself “seriously doubt[s] Trump’s objections to USAID are moral”. More likely Trump’s attack on USAID is a privatization move: “Trump’s goal is most likely to purge & take control of the soft power arsenal rather than abolish”.
One might also look at what another powerful man thinks he’s accomplishing by smashing up USAID. Far-right billionaire Elon “pedo guy” Musk, who in 2020 endorsed US regime-change operations by tweeting “We will coup whoever we want!”, bragged about having spent a weekend “feeding USAID into the wood chipper”. Musk regards USAID as “a viper’s nest of radical-left marxists who hate America”. These are not the beliefs of someone attacking USAID for being a coup-friendly CIA cutout.
The bottom line
This isn’t a 5-dimensional chess problem. The key fact here is that Donald Trump, Marco Rubio, and Elon Musk are despicable and depraved men undertaking an administrative coup, with, at best, no regard for the welfare of foreigners. Their gleeful swings of the hammer have dented PEPFAR, threaten to destroy it, and have probably caused thousands of needless HIV infections already, disproprtionately of African children. Trump and Musk were dangerous enough in responding to the novel COVID-19 pandemic; now Trump, Musk, and Rubio insist on picking up an older pandemic and wielding it against the rest of the world. Treason against them is loyalty to humanity.