WASHINGTON — The President’s Emergency Plan for AIDS Relief, or PEPFAR, is an HIV/AIDS relief program established in 2003 under President George W. Bush and an example of foreign aid done well. Judging by a questionnaire from the Trump transition team to the outgoing Obama State Department, this program is one piece of U.S. foreign policy which could undergo radical changes under the Trump administration.
The questionnaire directly asks if PEPFAR is “becoming a massive, international entitlement program.” This skeptical view is unmatched by the President’s pick for Secretary of State, who sees PEPFAR as “extraordinarily successful.” While divergent views are plentiful in the incoming Trump administration, according to Trump spokesman Sean Spicer the executive nominees are giving their personal views, but, ultimately, they will “pursue a Trump agenda.”
Trump himself has expressed support for PEPFAR, at least on one occasion during the presidential campaign. On doubling the number of people receiving treatment through the program he stated: “Yes, I believe so strongly in that and we’re going to lead the way.” During his campaign announcement speech, however, he stated that the U.S. should “stop sending foreign aid to countries that hate us.” Later, he said humanitarian intervention should be determined by “how friendly they’ve (the countries) been towards us.”
This obvious contradiction between campaign rhetoric, the “personal views” of his nominees and the skeptical language of the transition team’s questionnaire poses a perplexing question. Just what will Trump’s stance on PEPFAR be, considering the euphemistic nature of his political speech? PEPFAR’s mission statement, operations and budget will reveal what exactly is at stake.
PEPFAR’s goal is to make a sustainable impact in the fight against HIV and AIDS while securing key partnerships with countries to promote human rights. It takes a dim worldview or ignorance of the facts to see this as “a massive, international entitlement program” in the pejorative sense of the word “entitlement.” PEPFAR is an entitlement to a life of health and decency for millions of people across the world.
PEPFAR states that it requires its programs to be “country-owned and country-driven,” i.e., not a program to be micromanaged by U.S. advisors. This means that the countries control the program to implement it in the ways they see it making the greatest impact while using U.S. expertise to make improvements. When you see a doctor, they may prescribe medicine or perform surgery, but won’t go with you to your home, change your bandages or feed you your pills. They leave it to you to follow their advice and take care of yourself in a way that makes sense for your specific needs.
PEPFAR was announced during President Bush’s State of the Union address and passed with bipartisan support in Congress. With a $15 billion initial five-year authorization, PEPFAR aimed to treat more than 2.1 million people, provide ongoing care for more than 10 million, including orphans and children. In 2008, PEPFAR was expanded to include a $48 billion five-year authorization for HIV/AIDS, tuberculosis and malaria, though HIV/AIDS funding made up 83 percent of the allocation. The increased funding would reach 24 million people across 30 nations and be met with collective support from the G8 countries.
In 2013, PEPFAR support brought HIV/AIDS testing and counseling to 57.7 million. This includes 12.8 million pregnant women, many of whom were then able to attain treatments to prevent their children from getting the disease. In 2015, PEPFAR helped 9.5 million people attain life-saving antiretroviral treatments, trained 190,000 new health care workers and helped 68.2 million people get access to HIV testing and counseling.
Since 2004, PEPFAR’s budget rose substantially every year until the reauthorization in 2008 when it reached around $6 billion. Since then, growth has been relatively stagnant with an average of $6.7 billion per year. The 2017 budget request numbers are the lowest since 2013, an amount around .007 percent of the preliminary 2017 outlays listed in the Congressional Budget Office’s December 2016 budget review.
PEPFAR is a strategic part of a proactive foreign policy which, in President George W. Bush’s words, helps to “alleviate the despair that allows extremism to take hold.” In 2015, this program alone made up more than 27 percent of the world’s total low-middle income country AIDS response funding, according to UNAIDS numbers, and it is estimated that the 2020 requirements for funding will be $26.2 billion.
2030 estimates suggest that world AIDS response as it is now is working. Even if we can’t be sure as to what President Trump is planning to do with PEPFAR, we do know that the program plays an instrumental part in the global fight against HIV/AIDS, and truly represents what makes America an exceptional nation. Contact the White House and your Congressional leaders so we can keep it this way.
– Lucas Woodling