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Author: Yolaine Frossard de Saugy, PhD Candidate, International Relations, McGill University
Original article: https://theconversation.com/trump-white-houses-disengagement-from-hiv-aids-response-could-have-lethal-consequences-249261
With the endless stream of announcements, reversals, measures and countermeasures coming from the new administration of United States President Donald Trump, it has become difficult to make sense of what is just noise or opening negotiation offers and what constitutes actual policy change.
Unfortunately, in the case of the global response against HIV/AIDS, it seems the attacks go beyond bluster.
The methods used in the fight against HIV/AIDS have long been disputed, but overall commitment to the response was one of the few deeply bipartisan endeavours left, until now. Undercutting this decades-long consensus would mean endangering millions of lives.
U.S. role in global HIV/AIDS response
As a PhD candidate in international relations working on the politics of the response to HIV/AIDS, I am very aware of the central role that the U.S. has played in building and sustaining a global response to the epidemic in the past 25 years.
The U.S. is the largest provider of funds for HIV/AIDS programs worldwide. It does so mainly through the bilateral President’s Emergency Program for AIDS Relief (PEPFAR) as well as through its contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Overall U.S. funding for global AIDS reached $7 billion in 2020, 2021 and 2022. PEPFAR alone is estimated to provide treatment to 20 million people.
(AP Photo/J. Scott Applewhite)
The U.S. is also a fundamental participant in HIV/AIDS research, including through the work of the Centers for Disease Control (CDC) and the National Institutes of Health (NIH), as well as USAID.
All of this involvement has already been dangerously jeopardized by the actions taken by the White House since Trump took office for his second term.
Many activities of the CDC and NIH have been halted. Funding for PEPFAR was caught in the freeze on foreign aid announced in January. Though an exemption was later made and the order has since been blocked by a federal judge, it has already forced recipients of aid to lay off personnel and close clinics and programs in places like Kenya and South Africa.
USAID, the primary implementer of bilateral HIV/AIDS funds, is at risk of being dismantled.
Current changes
The chaos wrought by these measures has impacted the response to HIV/AIDS in deep ways, even if they may be contested or reversed by the courts and Congress.
The uncertainty in itself is damaging for programs that need reliable funding and long-term planning, not to mention the clinical trials that have been brutally interrupted. What’s more, there are indications the Trump administration and other Republicans have abandoned the longstanding commitment to the response itself, which may lead to irreparable damage.
American involvement in the global response to HIV/AIDS has long been shaped by domestic politics. Most notably, PEPFAR’s first rounds of funding were deeply constrained by the views of George W. Bush’s evangelical constituency, including in its focus on abstinence as prevention and denial of funding for sex workers.
But the overall commitment to fighting HIV/AIDS had enjoyed bipartisan support for over two decades. Even during the first Trump administration, the U.S. maintained its involvement, though this was also due to Congress’s resistance to the White House’s attempts at reducing funding.
(AP Photo/Evan Vucci)
There are indications that things might be different this time. Entire pages on HIV/AIDS have disappeared from government websites.
The Heritage Foundation, the conservative think-tank behind the potential blueprint for Trump’s government known as Project 2025, has referred to HIV/AIDS as a lifestyle disease, like tobacco consumption. This language is reminiscent of the 1980s playbook of opponents on AIDS action and negates both the nature of the epidemic and the realities of those who live with the virus, casting doubts on the need to engage meaningfully with the response.
Most ominously, the last reauthorization of PEPFAR in 2024 was limited to one year instead of the customary five, as some Republican representatives sought to end it altogether. This means the entire program is to be re-examined this March with no guarantee of how the debates will unfold, especially in the current climate.
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As the United States disavows the World Health Organization, Canada must double down on its support
Ultimately most will depend on Congress, including the amount pledged by the U.S. to the Global Fund at its replenishment conference sometime this year.
Its decisions will be the real test of the depth of change on this matter, though everything that has unfolded so far hints at a far-reaching shattering of the consensus. If conservative Republicans maintain their pressure on PEPFAR, the program could be significantly diminished, and it is unlikely that a White House that withdrew from the World Health Organization on day one will act decisively to save it or insist on a sustained contribution to the Global Fund.
Consequences of U.S. disengagement
The consequences of a U.S. retreat from the global response to HIV/AIDS would be immense.
In the short-term, millions of people would lose access to the treatment they depend on for their survival. In the long term, shrinking American funding would undermine health systems around the world and risk the resurgence of the pandemic and the rise of resistant virus strains.
This would jeopardize 40 years of progress, returning us to a time when AIDS was considered a key security risk and threat to development.
THE CANADIAN PRESS/Sean Kilpatrick
Even if funding is maintained, all of this shows that for the next few years the U.S. is unlikely to be reliable. This means others will have to take up the leadership to ensure the worst-case scenario is avoided.
Among these, Canada could have a crucial role to play. It has long been a key entity in its own right — the seventh largest contributor to the Global Fund — though Ottawa has remained discreet in this area so far. Washington’s withdrawal from the field may force it to step into a more visible role and contribute to reframe Canada’s international involvement.