Indeed, Obama has taken flak from congressional Democrats and Republicans for halting the year-on-year rise in PEPFAR funding, and slightly reducing it on several occasions. “The current administration’s comparative neglect of it demonstrates that its existence and survival are anything but guaranteed,” wrote Dylan Matthews in 2015.
Defunding the program would be catastrophic. Antiretroviral drugs aren’t a cure for AIDS; they must be taken continuously, lest the disease flare up again. “To sustain that therapy, there are substantial pipelines involving supply chains, financing mechanisms, and myriads of organizations,” says Chow. “Disruptions risk rekindling HIV.”
Trump has actually commented about PEPFAR once—sort of. At a conference in October, a group of college students asked him if he would commit to doubling the number of people receiving treatment through the program to 30 million by the year 2020. “Those are good things,” he replied. “Alzheimer’s, AIDS. We are close on some of them. On some of them, honestly, with all of the work done which has not been enough, we’re not close enough. The answer is yes. I believe strongly in that and we are going to lead the way.” If you squint a bit, that looks like a yes. But as I noted last month, it’s unclear if Trump actually understood the question, given that PEPFAR doesn’t cover Alzheimer’s.
More encouragingly, Rex Tillerson, former ExxonMobil CEO and Trump’s nominee for Secretary of State, unequivocally praised PEPFAR during his Senate confirmation hearing last week. It “has been one of the most extraordinarily successful programs in Africa,” he said. “I saw it up close and personal because ExxonMobil had taken on the challenge of eradicating malaria because of business activities in Central Africa.” (ExxonMobil is one of several companies that contribute to the Global Business Coalition on HIV/AIDS, Tuberculosis & Malaria.)
Tillerson’s answer hints at something crucial: PEPFAR’s impact goes well beyond AIDS. It also helps to curtail future epidemics that begin in sub-Saharan Africa and threaten to spread to other continents. “What do we do to keep Ebola out of the U.S.? We build capacity in the countries that need it most,” says Katz. “And PEPFAR has unquestionably contributed to building foundations for systems that can be used to fight the next pandemic.”
And since AIDS hits people of working and reproductive ages the hardest, the social benefits of controlling it are huge. Compared to other countries, those targeted by PEPFAR have a better opinion of the U.S. Their male employment rates are 13 percent higher, creating economic benefits that are equal to half the amount spent. They have developed three times faster. Their levels of political instability and violent activity have fallen by 40 percent since 2004, compared to just 3 percent in non-PEPFAR countries. All of this benefits the U.S., creating markets for exports and reducing the instability that leads to extremism.