“A whole new level of cruelty”: Health experts decry “devastating” cuts to HIV treatment programs

How did Anja Giphart learn that more than 350,000 people who depend on her organization to treat their HIV would be denied that life-saving care, effective immediately? An email announcing that the work was “being terminated for convenience and the interests of the U.S. Government,” all but ensuring that, among other things, scores of women will give birth to children who then die of AIDS. The notice, obtained by Salon, ended with the sign off: “Thank you for partnering with USAID and God Bless America.”

The Elizabeth Glaser Pediatric AIDS Foundation, where Giphart serves as acting president, is named after its founder, who in 1981 contracted HIV from a contaminated blood transfusion and then unknowingly passed it to her infant daughter. She died in 1994 after creating the foundation to help stop the spread of HIV from mothers to their children.

In several countries across Africa, that work — which includes testing and providing antiretroviral drugs — will no longer be conducted; not by EGPAF or, in the immediate future, anyone else. In the Feb. 26 email from an address at the U.S. Agency for International Development, the government body all but eliminated by billionaire Elon Musk and his Department of Government Efficiency, informed EGPAF that it was nixing contracts for its work in Lesotho, Eswatini and Tanzania, in an instant suspending care for nearly 10,000 children and 10,000 HIV-positive mothers. According to Giphart, the group also is being forced to suspend work in Mozambique and the Democratic Republic of Congo, where its partner organizations have just lost funding.

“To suddenly pull out, it will mean that there will be people not able to access their treatment and, ultimately, that will result in people dying,” Giphart said. “It will also result in treatment resistance,” she said — strains of HIV that evolve to make medication ineffective — “and, as we all know, that will not just stay in those countries where it develops, that will also reach the United States.”

That the Trump administration is canceling contracts that help prevent the spread of HIV came as a surprise not just to aid organizations but, perhaps, to anyone who listened to and believed Secretary of State Marco Rubio. In a Feb. 10 radio interview with conservative pundit Scott Jennings, Rubio assured listeners that he was a supporter of such initiatives, funded under the U.S. President’s Emergency Plan for AIDS Relief, an effort launched by former President George W. Bush and better known as PEPFAR.

“I’m a supporter of PEPFAR. I have been in Congress. I am now as secretary of state,” Rubio said of the $7.5 billion program, credited by the State Department with providing treatment to more than 20 million people and preventing at least 5.5 million babies from being born with HIV. “It’s a program we want to continue.”

About two weeks earlier, Rubio had issued a statement promising that he would issue waivers to protect “life-saving humanitarian assistance” from Musk and Trump’s efforts to suspend and ultimately curtail foreign aid. A subsequent waiver for PEPFAR allowed the distribution of HIV treatment drugs to resume for women and children, but continued to bar efforts aimed at preventing HIV transmission among sexually active adults. (The Washington Post reported that some programs approved by Rubio were nonetheless manually blocked by DOGE operatives with control over the U.S. government’s finances.)

At the same time, Rubio pledged to conduct a 90-day review of all such assistance, his State Department now charged with taking over — illegally, critics say — the work of USAID.

That review is apparently over, resulting in the cancellation of thousands of contracts with humanitarian organizations working to prevent the spread of disease, from HIV to tuberculosis, news that was first leaked to right-wing media: the Free Beacon, a conservative outlet, obtained a State Department memo that rationalized the cuts in MAGA-friendly terms.

“Every dollar we spend, every program we fund, must be justified with the answer to three simple questions: Does it make America safe? Does it make America stronger? Does it make America more prosperous?” the memo stated.

In light of Rubio’s previous comments, groups that provided HIV treatment, in particular, were surprised to learn — the same curt email was sent to scores of NGOs — that their work is now deemed at odds with the fortunes of America.

“We were mostly caught by surprise because we felt those programs, at least our programs that were terminated, clearly fell under the PEPFAR waiver and therefore we did not expect this to happen,” Giphart said.

It’s not clear why EGPAF’s work was targeted for elimination, but it is clear that it will have broad implications.

Beatriz Grinsztejn, an infectious disease expert and president of the International AIDS Society, told Salon that the cancellation of such contracts will have ripple effects, impacting every aspect of the global effort to stop the spread of HIV. “The US funding cuts are dismantling the system,” she said. “HIV treatment is crumbling.”

The State Department did not respond to a request for comment. But right-wing critics of PEPFAR have targeted the program on anti-choice grounds, with a group of Republican lawmakers in January complaining that nurses at some clinics that received PEPFAR funding in Mozambique provided a total of 21 abortions over four years.

The Heritage Foundation, the conservative think tank behind Project 2025, likewise accused the Biden administration of using PEPFAR to promote a “radical social agenda overseas,” namely “the LGBTI agenda,” noting that Democrats had argued that it should promote contraception to prevent the spread of infection (in the past, Republicans required PEPFAR recipients to promote abstinence-only education). Social conservatives have taken particular issue with the distribution of condoms and pre-exposure prophylaxis, or PrEP, which prevents HIV transmission and is cast as enabling promiscuity, particularly among the LGBTQ+ community.

That still does not really explain why EGPAF, in particular, would be targeted, according to Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition, or AVAC.

“The single most effective organization for 20-plus years in the area of mother-to-child transmission is the Elizabeth Glaser Pediatric AIDS Foundation,” he said in an interview. “If Secretary of State Rubio really were honest about supporting PEPFAR and believing it was life saving and wants it to continue, he wouldn’t have canceled the major contracts that EGPAF currently leads.”

As it stands now, PEPFAR, despite the rhetoric, “is not just limping along — it is crippled,” Warren said.

The actions taken by the Trump administration so far point to a PEPFAR that will continue to exist but only in a limited capacity, if not name only, perhaps restricted to preventing mother-to-child transmission (despite such efforts also being curtailed right now). The ever-present culture war is part of it — the idea that preventing HIV transmission among adults enables promiscuity — “but I think it’s more insidious that that,” he said: “It is clearly the complete dismantlement of the foreign assistance apparatus,” and a “trial balloon” for slashing government not just abroad but at home, where medical assistance for the poor is next up on the chopping block.

Want a daily wrap-up of all the news and commentary Salon has to offer? Subscribe to our morning newsletter, Crash Course.

If Republicans wished to phase out foreign aid, Congress could pass a budget doing so and groups that rely on it could at least try to phase out their assistance or find alternative sources of funding. That assistance is being suddenly ripped away, leaving the most vulnerable without an alternative for treatment, suggests that those doing so do not care either about those affected or how the actions will be perceived by former allies and the broader world.

“Take the chaos and confusion that has grown each day for five weeks — what’s transpired over the last three or four days just takes it to a whole new level of cruelty and inhumanity and, frankly, a whole new level of stupidity in doing this is the most non-strategic way,” Warren said.

An orderly cancellation of EGPAF’s contract — any sort of heads up — might have allowed others to step in and fill the void. But in the developing nations where this work is so necessary, the group’s president told Salon that local governments and NGOs do not have the capacity of a global superpower and cannot easily replace it; not now and perhaps not ever. “Definitely not at such a short notice,” Giphart said. “Changing this overnight, they are not prepared to take this on.”

That means mothers and their children will immediately stop receiving treatment, and that, in turn, means many will be killed, and soon.

“Ultimately, if there is no HIV treatment available for pregnant women, their viral load will go up, and there is an increased risk again that they will transfer the virus to their infants,” Giphart, a medical doctor and public health expert, told Salon. “If the child is infected during pregnancy, labor or delivery, the child has a 50% chance of dying before their first birthday if they are not put on treatment. So the time element, I think here, is also important: People will die if there is no treatment available; children will get infected again.”

“We’ve made so much progress,” Giphart said. “To see this happening overnight is just really devastating.”