Three-hundred thousand deaths per year.
That’s the human cost of President Donald Trump’s proposal to cut more than $1 billion cut from global HIV funding in 2019, a 20% reduction from current levels, according to a report by the ONE campaign. And it comes just when American-led efforts are paying off, and the global tide of the epidemic appears to be turning.
Ironically, the proposed cut lands mostly on the program responsible for America’s success in this area, PEPFAR (the President’s Emergency Plan For AIDS Relief), initiated by George W. Bush and beloved of Trump-voting evangelical Christians – today, many leading HIV relief organizations are religiously affiliated.
There has been bipartisan support for PEPFAR over the years, but Trump’s budget cuts it by $800 million, in addition to $425 million to be cut from the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Both would be unprecedented cuts for the agencies.
And yet, PEPFAR is working. Based on epidemiological research, PEPFAR alone is credited with saving 11 million lives over the past 15 years. PEPFAR was also a catalyst for other countries, and private actors, to invest more and to combat other diseases at the same time as HIV.
These efforts have yielded significant results. There has been a 47 percent decrease in AIDS-related deaths since 2003, and new, inexpensive anti-retroviral medications have turned the tide in several countries.
Meanwhile, USAID, PEPFAR, and the United Nations have committed to the goals of, by the year 2020, diagnosing and treating 90% of people with HIV and reducing new infections to 500,000 per year. Globally, it is estimated that 36.7 million people are living with HIV. At present, 17 million of them are not receiving any form of treatment.
These are not only humanitarian successes but strategic ones as well. At its worst, the HIV epidemic has destabilized U.S. allies; controlling the epidemic means reducing chaos. And from a purely self-interested point of view, HIV relief is part of the United States’ “soft power,” which maintains its leadership position relative to adversaries like Russia and China.
The reaction of LGBTQ and HIV advocates has been predictable: a consortium of HIV organizations wrote to congressional leaders last fall, when the cuts were first rumored, “worrying that the U.S. commitment to ending AIDS is waning.”
Now that the cuts are actually in the proposed budget – similar cuts were rejected by Congress last year, and most likely will be again – the response has been swift.
“The United States has been a leader in the fight to end the AIDS epidemic around the world and these programs are vital to the health of millions around the world,” David Stacy, Government Affairs Director at the Human Rights Campaign, told the Daily Beast. “The Trump-Pence Administration is abandoning a bipartisan effort that Presidents Bush and Obama championed. Cutting essential funding for these life-saving services jeopardizes not only LGTBQ people but significantly undermines the overall health infrastructure in these countries.”
Former president Bush himself took to the Washington Post last year, when Trump proposed a smaller cut to PEPFAR in the 2018 budget. “When we confront suffering — when we save lives — we breathe hope into devastated populations, strengthen and stabilize society, and make our country and the world safer,” Bush wrote. “We shouldn’t spend money on programs that don’t work, whether at home or abroad. But [the government] should fully fund programs that have proven to be efficient, effective and results-oriented.”
The question, then, is why. Why now? Why cut a program that is working, that is supported by people across the political spectrum, and that is tiny in comparison to other government programs? (Trump’s budget adds about $12 billion to military spending, bringing the total to $686 billion.)
The Trump administration is saying nothing. U.S. Global AIDS Coordinator Ambassador Deborah Birx said during the last round of proposed cuts that “Translating that money into the most effective programs that we can, that reaches the most lives in the most impactful way — that’s our job.” In other words, ‘we’ll make do with what we’ve got and I’m not going to say anything bad about my boss.’
Presumably, some of the impetus from the cuts comes from an “America First” philosophy that American strength is defined solely by how big the button is on Trump’s desk, rather than by how America leads worldwide in issues like global health. That’s why the State Department is in tatters, with empty offices throughout the Truman Building, while the Pentagon is going back on steroids. Why bother making friends when you can defeat your enemies?
Or perhaps the administration believes that others will step in to fill the void America leaves behind: private foundations, other governments, the tooth fairy. Let someone else foot the bill for a change, right?
Or maybe no one in the White House really cares how many Africans die of AIDS.
Or it may be that the cut to global HIV funding is part of the administration’s overall abandonment of people with HIV. Domestic HIV spending is also being slashed in the new budget. And recall, Trump recently fired the entire Presidential Advisory Council on HIV/AIDS – apparently over their refusal to endorse ineffective ‘abstinence only’ programs – and has closed the White House Office of National AIDS Policy.
If HIV is being singled out, that, too, begs the question of why. For almost two decades, national Christian organizations have moved beyond the stigmatization of HIV/AIDS that marked the 1980s and 1990s. As Bush’s op-ed pointed out, 2 million babies have been born to HIV-positive mothers without passing on the infection. WorldVision, a Christian global relief organization, is running HIV prevention programs in Africa.
Are we really going back to the Eighties, when HIV/AIDS was a “gay disease” and Reagan White House officials joked about it? Trump himself seems trapped in the decade – making comments about Haitians having AIDS, for example. Is that what this is all about? Is that the reason for the slashing of effective health programs here and abroad?
And if not, then what is it?
Correction: This article has been updated to reflect the correct proposed cut to the Global Fund to Fight AIDS, Tuberculosis, and Malaria. It is $425 million, not $225 million as originally reported.