PEPFAR: The American Freeze on Foreign Aid, and its Effects on HIV in our Community
- Kieran Taylor
- 5 days ago
- 5 min read
To most Americans, the HIV/AIDS epidemic is not the crisis that it once was. From its outbreak in the 1980s to the early 2000s, the United States scrambled to perform damage control on multiple fronts - not only the public health crisis that claimed the lives of hundreds of thousands of Americans, but also the ensuing moral panic that fueled fear, stigma, and dangerous misinformation about the nature of the disease. Thankfully, many factors coincided to heavily reduce the impact of HIV in America: for example, celebrities’ disclosures of their own diagnoses (like those from Magic Johnson, Eazy-E and Freddie Mercury) helped to convince Americans of the disease’s risk to people of all sexual orientations. Concerted efforts from the scientific community, backed up by bipartisan federal support, vastly expanded harm reduction practices and improved their effectiveness; needle exchange programs, educational programs, and the availability of medications like pre-exposure prophylaxis (PrEP) were instrumental in preventing the spread of HIV from expanding out of control. Today, over a million Americans still live with the disease - but with testing, treatment and many other advancements to patients’ quality of life since the crisis’ peak, and annual HIV-related deaths plunging over the past two decades, it’s commonly perceived among citizens as having been “beaten.”
For the citizens of many developing countries, however, HIV remains just as much a threat as ever. Stigma in countries such as Ethiopia persists and permeates everyday life, with even the mention or discussion of the disease commonly deemed a taboo - precluding lifesaving mitigation practices like basic education about it and publicly-available testing. As a result, countless people around the world are living their lives unaware that they have been infected, and are unlikely to ever find out, let alone receive treatment. Well over half a million people died from HIV/AIDS-related illnesses in 2023 alone, per UNAIDS; nearly 40 million people lived with the disease that year, up to 5 million of whom were unaware that they had it. 44% of new infections affect women and girls, despite persistent stereotypes about it largely affecting men. While staggering, these figures are a far cry from what they used to be, as new infections have fallen 60% since 1995. This is due in no small part to comprehensive foreign aid efforts from developed countries like the USA.
Though there is no single program encompassing all international efforts to address the global HIV epidemic, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) is among the most notable. Since the program’s introduction by Pres. George W. Bush in 2003, the US government has since allocated over $110 billion to it, making it not only the largest investment a country has ever made against a single disease, but also the largest global health program focused on a single disease until the Covid-19 pandemic. This involves a broad range of resources and programming, including preventative measures like testing and public education, support for local health systems, and notably, lifesaving treatment and medications - particularly anti-retroviral (ARV) drugs that are inaccessible for many citizens. As a result, PEPFAR has saved over 26 million lives from HIV/AIDS-related deaths, particularly in its 15 focus countries (predominantly in sub-Saharan Africa, including Ethiopia).
Though widely celebrated as a crowning achievement in the global fight against HIV/AIDS, PEPFAR’s future is uncertain. Last year, it was unable to re-secure a full five year’s funding for the first time, reauthorized for just one year, which expired on March 25th amidst the current presidential administration's blanket freeze on foreign aid. Pressures to reduce funding to foreign countries and programs therein had been increasing scrutiny on PEPFAR’s expense, sharpened all the more as it was dragged into the hot-button issue of abortion as anti-choice politicians zeroed in on its alleged support of the practice. And as US political controversies continue to churn around the program, calling into question its continued existence, the recent 90-day freeze is providing just a taste of what its absence will entail. With its reauthorization date having now come and gone, PEPFAR currently has no prospects for renewal - and while some programs under it are able to continue as long as Congressional appropriations allow them to, many of the administering bodies in charge of PEPFAR programs (such as USAID) are either being terminated themselves or at high risk of it.
The aid provided to Ethiopia through PEPFAR has allowed for remarkable strides to be made against HIV/AIDS’ spread and the threat it poses to Ethiopian citizens, but by no means has it been neutralized. We at Studio Samuel have seen firsthand the heartbreaking effects that an HIV infection can have - not only on the infected individual, but on their families and loved ones who rely on them, or must take care of them. ARV drugs are crucial to the survival of many people living with HIV, children and adults alike, but are prohibitively expensive (or simply not available at all) without the help of PEPFAR.
“My name is Hasaet, and I am 13 years old. I have been taking HIV medicine to stay healthy. But if I cannot get it for free, my father will not be able to buy it himself. This makes me very scared because I don’t want to die now. I want to grow up, go to school, and have a future. I want to play with my friends and live a happy life.”
- Hasaet, Studio Samuel student
Studio Samuel introduced our HIV/AIDS Prevention Course the same year that we opened our training center’s doors back in 2015, after discovering that one of our students had become her HIV+ mother’s sole caregiver - at just ten years of age. Since then, we have continued to provide educational resources for each class of girls, and despite having to pause the program briefly in 2019, our partners at the White Feather Foundation have enabled us to keep the program going. All girls who participate receive a free HIV test, helping to break the stigma that would otherwise prevent them from learning about the disease, how to avoid it, and whether they had been exposed.
“I am a single mother of three children. I take HIV medicine for free, but if it is not available, I have no way to get it. This worries me a lot because my children have no one else to take care of them. If I die because I cannot get my medicine, they will be left alone. Every day, I pray to God, asking Him to keep me alive until my children grow up.”
- Selamawit, community member
Unfortunately, our work to educate our community about the dangers of HIV and provide resources like testing can only go so far to addressing its effects on our students and neighbors. PEPFAR-funded programs are crucial to dismantling the taboos that obstruct proper treatment and prevention, and PEPFAR-funded medication is, in no uncertain terms, the difference between life and death for countless people around us. The health complications of living with HIV, particularly when untreated for lack of medication, are only compounded by other factors like poverty (with some community members forced to beg in the streets to support their families), violence against women, and the stigma against seeking support at all.
I am living with HIV relying on essential ARV medication to stay healthy. The thought of not being able to continue getting the medication for free fills me with fear. [Inability] to get the medicine for free affects the whole life of our family as I am not able to afford the medicines. After I heard the news [about PEPFAR] I am always worried about my older mother and father - who is helping them if I die?”
- Adeba
As we await an update on the continuation of this vital support from the US government, please remember that freezes and cuts to aid programs like PEPFAR go far beyond domestic political disputes, and will have a disastrous impact on innumerable people in Studio Samuel’s community and around the world. We will continue our efforts to support our students and their families, but we cannot do so without your help.
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