Trump is sentencing to death 26 million people...and counting

Ending a two-decade program to give people in poor countries anti-HIV medication will cause millions to develop AIDS and die. It's also a massive national security disaster.

PEPFAR photo essay on 15th anniversary.

The Trump administration cruelly and abruptly stopped the distribution of life-saving antiretroviral drugs to almost 26 million people worldwide. The program, the President’s Emergency Plan for AIDS Relief—PEPFAR—is the global health program started by Republican President George W. Bush in 2003. He celebrated the 20 year anniversary in 2023 at his presidential library.

While the White House has called this a “pause,” The New York Times described it in more dire terms:

On Monday afternoon, officials worldwide were alerted that PEPFAR’s data systems would shut down at 6 p.m. Eastern — roughly three hours after the email was received — immediately closing off access to all data sets, reports and analytical tools.

“Users should prioritize copying key documents and data,” said the email viewed by The Times.

The message prompted speculation that the program would not resume, as its future was already in question.

The Times noted, in what seems like pure evil, that the administration, “has instructed organizations in other countries to stop disbursing H.I.V. medications purchased with U.S. aid, even if the drugs have already been obtained and are sitting in local clinics.”

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Without the drugs for any length of time, HIV will replicate inside the bodies of these HIV-infected people in poor countries across Africa, Asia and elsewhere, who have been living and thriving, as HIV has thankfully become a manageable illness because of the drugs. HIV will be able to transmit from them to others—transmission is suppressed while taking the drugs—and more powerful, drug-resistant strains could emerge which would affect everyone around the world, including in the U.S. and including those on current treatment.

And they will develop full-blown AIDS, suffer immensely, and die.

It’s as simple as that.

Let’s be clear, for Trump this is eugenics, killing off the non-white people in the “shithole” countries who he surely believes we shouldn’t be spending money on.

Trump has promoted eugenics—spouting off about “good genes” and “bad genes” in talking about immigrants he wants to deport who he says are “poisoning the blood” of Americans—and, according to his own nephew, said disabled people should “just die” in the context of his nephew’s own son.

So none of this is speculation. Trump is a racist and believes people with debilitating illnesses should “just die.” PEPFAR survived Trump’s first term, even though he did move to harm it. PEPFAR must be continually renewed by Congress in bills the president in office has always signed.

Trump’s proposed budget in 2017 would have severely harmed the program, though not destroy it entirely. In the end, Trump extended funding with no major cuts, signing the PEPFAR Extension Act of 2018, and the administration even touted it on the State Department’s website, in a post that is still there:

This marks another significant moment in the U.S. President’s Emergency Plan for AIDS Relief’s (PEPFAR) history of lifesaving work. In the past 15 years, PEPFAR has enjoyed tremendous bipartisan support from eight U.S. congresses and has been supported by three consecutive U.S. presidents. Since its inception, PEPFAR has saved over 17 million lives, prevented millions of HIV infections, and transformed the global AIDS response from death and despair to life and hope.

But, as we’ve seen, Trump in 2025 is far different. It’s not just that there aren’t people around him who can rein him in; there are people around him encouraging these actions.

Add to Trump’s racism and obsession with eugenics the fact that the people in place in his administration from Project 2025 just want to cut all foreign funding of any kind in their dangerous America First zeal, and want to slash funding to Americans’ social safety net as well. His nominee for Office of Management and Budget director, Russell Vought, a major contributor to Project 2025, is making that clear, seeking to target Medicare and Medicaid and other programs, even admitting it during his Senate confirmation hearing.

Then there’s the power of the Christian right—and Vought is also a devout evangelical Christian nationalist—which sees HIV as a sexually transmitted disease that could be “controlled” via behavior. But more so, abortion is at play here—or at least is something they’re blowing up to add into the mix.

Republicans last year accused PEPFAR of funding abortion. The evidence: Four nurses who distribute the drugs to people with HIV in Mozambique, where abortion is legal, also separately performed 21 abortions. Nothing linked the PEPFAR money to the abortions, but providers of the drugs are barred under the law from also performing abortions, period.

Whatever the case, this was an isolated incident in the context of 26 million people receiving the drugs worldwide. Nonetheless, Senate Republicans would only sign on to a one-year extension in 2024, with the Christian nationalist base pressuring them.

Then you have to add to all of this the fact that Trump is intent on making RFK Jr. his Health and Human Services Secretary. RFK is a crackpot and AIDS denialist who believes HIV doesn’t cause AIDS, a public health conspiracy theory that goes back to the 1980s and has no basis in scientific fact:

Despite firm scientific evidence that H.I.V. infections cause AIDS — some of which was recognized with the Nobel Prize in 2008 — Mr. Kennedy has repeatedly questioned the link.

“There are much better candidates than H.I.V. for what causes AIDS,” he told a New York Magazine reporter in June 2023.

He has suggested that possible causes of AIDS include environmental toxins and “poppers,” an inhaled drug and immunosuppressant popularized by gay men during the 1970s.

But studies have looked at whether factors like drug use, sexual behavior and bacterial infections were associated with AIDS. They have all come to the clear conclusion that “the only common denominator” was H.I.V., according to the National Institutes of Health.

This is just homophobic blather dressed up as something else. RFK may as well be a Christian nationalist himself.

The bottom line is that Trump has these people in his ear, coming from various perspectives—from talking about the costs that are incurred to pushing conspiracy theories not based in the science—and they’re all feeding his racist impulses.

The humanitarian crisis will be a calamity. But HIV, for a variety of reasons, has also been deemed a national security crisis, and that’s why a Republican president—George W. Bush—whose own father bowed to Christian conservatives regarding AIDS when he was president, realized the U.S. needed to be instrumental in stopping the transmission of HIV globally. In April of of 2000, the U.S. government under Bill Clinton declared AIDS a national security threat, entrusting it to the work of the National Security Council, something every president since—and lawmakers in both political parties—have understood. From the Journal of American Medical Association in October of 2002:

Security has been broadly defined as both the freedom from fear and the freedom from need.⁴ Under this definition, HIV/AIDS threatens the security of governments and economies around the world because of its ability to simultaneously endanger political stability and depress current levels of prosperity. According to one study, a significant decrease in life expectancy is the strongest risk factor for ethnic conflict, genocide, failure of fledgling democracies, and revolutionary wars.⁵

In sub-Saharan Africa, for instance, average life expectancy rates will drop 25% in the next few decades from 59 years to less than 45 years, solely due to HIV/AIDS.⁶ Stable leadership may collapse if death rates continue to rise among public and private elites, including the police force and the military, where HIV prevalence rates have reached 60% in countries such as Angola and the Democratic Republic of the Congo.⁷

Beyond that, Bush and many Republicans understood, along with Democrats, that if the U.S. doesn’t fill the vacuum on desperately needed aid, countries will seek help from our adversaries, most notably China. Already, in the crisis over the Trump administration’s deportations of recent days, some countries have noted it:

After Mr. Trump signed executive orders this week aimed at sealing the U.S. southern border, expelling migrants and slashing foreign aid, Honduran officials said such measures could push their country closer to China, even as Mr. Trump has criticized China’s advances in Latin America.

Enrique Reina, the Honduran foreign minister, said in a television interview this week that while the United States provides his country with important help, Honduras had increasingly been approaching other countries, including China.

While Colombia has been a staunch ally of the U.S. and has criticized China, its second largest trading partner is China, after the U.S. After Trump’s ramping up the threat of a trade war with Colombia, you could envision the country shifting more toward China (something the Colombian president insinuated in his very forceful message to Trump), at least economically, so as not to be impacted by Trump’s blackmailing threats.

So, many countries in need— such as those battling the scourge of HIV—might be forced to turn to help from China, which of course will have strings attached. MAGA just doesn’t understand that the U.S. supports other countries because of its own self-interests, to stabilize governments and economies—which actually prevents migration—and to keep people from turning to our adversaries.

And Trump himself is too blinded by his racist rage, and his cruel desire to let people “just die,” to see any of that.

UDPATE: After the outrage to Trump’s actions and noise we all made, the Trump administration has reversed and will be sending the drugs for “treatment” -- for now, with the program still in jeopardy in the long-term. It's not clear, however, that the will distribute the drugs for "prevention." People who are not infected HIV who take an anti-retroviral daily (for example, if they're married to someone with HIV and wants to protect themselves) are protected from infection with HIV. From The New York Times:

The Trump administration on Tuesday issued a waiver for lifesaving medicines and medical services, offering a reprieve for a worldwide H.I.V. treatment program that was halted last week.

The waiver, announced by Secretary of State Marco Rubio, seemed to allow for the distribution of H.I.V. medications, but whether the waiver extended to preventive drugs or other services offered by the program, the President’s Emergency Plan for AIDS Relief, was not immediately clear.

Still, PEPFAR’s future remains in jeopardy, with potential consequences for more than 20 million people — including 500,000 children — who could lose access to lifesaving medications. Without treatment, millions of people with H.I.V. in low-income countries would be at risk of full-blown AIDS and of premature death.

“We can very rapidly return to where the pandemic is exploding, like it was back in the 1980s,” said Dr. Steve Deeks, an H.I.V. expert at the University of California, San Francisco.