This article is part of our series exploring the role of faith-based organizations in providing vital support and care to those affected by HIV/AIDS through PEPFAR. Throughout this series, we will highlight the importance of a clean, five-year reauthorization of PEPFAR to ensure the stability and continuity of lifesaving treatment.
The ever-growing number of policy and program changes under the Trump Administration has stirred a wide range of emotions across the country. It can feel overwhelming to keep pace with the shifts in domestic and foreign policy, and even more difficult to grasp the real-life impact of each decision. Regardless of where we stand politically, the current climate is exhausting. As Christians, how might we respond in ways that reflect our beliefs and honor the dignity of others? Can we recognize that policies that we support and celebrate may cause real fear for our neighbors? Are we willing to examine how our actions—or inaction—may contribute to the growing divisions in our country and within the Church, especially when we “other” those who look, worship, or vote differently than we do?
The answer is not to stay in our circles of comfort, but to reach over to those on the other side. We should be evaluating policies and programs not merely by the party that supports them, but by the ways they bring about or hinder human flourishing. Do they support biblical principles of truth, compassion, justice, healing, and love? Are they administered in line with the biblical principle of stewardship?
Stewardship means recognizing that we own nothing; everything we have, including our lives, has been given to us as a gift to fulfill God’s purposes (not our own) on earth. We are called to love God with all of our heart, soul, and strength, and to love our neighbor as ourselves. This love extends to taking care of all of God’s creation. This biblical lens is crucial to Christians’ understanding of U.S. policies and programs, especially regarding what is largely considered one of the most successful global health initiatives of all time: The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).
In 2003, President George W. Bush created PEPFAR to combat the global HIV/AIDS epidemic. The impact of this program has been remarkable, with 26 million lives saved and millions of cases of HIV prevented, including an estimated 7.8 million babies born HIV-free. PEPFAR has enjoyed strong bipartisan support from every administration, including during President Trump’s first term when he signed the PEPFAR Extension Act of 2018. In recent years, however, PEPFAR’s work has been increasingly politicized and scrutinized, with accusations that PEPFAR was using government money to fund abortions globally, in violation of the Helm’s Amendment. As a result, Congress rejected a clean five-year reauthorization proposed by the Biden administration in 2024, instead passing a one-year reauthorization. Then, in January of 2025, The Centers for Disease Control and Prevention (CDC), one of the main implementing partners of PEPFAR, found that PEPFAR money in Mozambique was mistakenly used to pay the salaries of four nurses who conducted 21 abortions. Despite PEPFAR’s swift response to rectify the misappropriation of funds and good track record, concerns about foreign aid continued to escalate. In line with these concerns, on his first day back in the office, President Trump signed a 90-day review period for all foreign aid programs, including PEPFAR, and it was subsequently extended an additional 30 days. During this review, funding was paused while the Office of Management and Budget (OMB) determined whether each program aligned with the administration’s foreign policy priorities.
The 90-day review period ended over a month ago on April 19, 2025, but the Trump administration has not provided further guidance on the program. This period has had disruptive effects on the recipients of PEPFAR-funded medical care as well as U.S. government workers, global health practitioners, and the many PEPFAR partners. Global partnerships are scrambling to continue life-saving work without having had the time to prepare for a dramatic decrease or cessation in funding from PEPFAR. Times like these bring a stark reminder of the life-saving work of PEPFAR. Global health experts agree that, due to the discontinuation of PEPFAR funding, many people will unnecessarily die from HIV/AIDS and immune-related diseases because of delays in or termination of treatment and prevention services. A recent study estimated that the 90-day pause in PEPFAR funding will cause 60,000-74,000 excess deaths from HIV/AIDS in Sub-Saharan Africa by 2030. The likely effects of ending PEPFAR or carelessly and drastically restructuring the program will be devastating to global health.
On May 2, President Trump released his fiscal year 2026 budget proposal, which includes significant decreases in funding to the CDC and global health programs and the restructuring of the United States Agency for International Development (USAID) under the U.S. State Department. While the proposal states that PEPFAR will continue to have funding for any current beneficiaries, the future success of PEPFAR is still uncertain as the reduction and restructuring of its biggest implementing agencies have left it without the critical infrastructure to operate. The likely effects of ending PEPFAR or carelessly and drastically restructuring the program would be devastating to global health.
As Christians, what are some ways that we can think about the ethics of ending or restructuring a critically important program like PEPFAR? Here are a few principles that I believe should guide our thinking.
We should support policies that move…
1. From confusion towards clarity
Many of the countries that have partnered with the U.S. since PEPFAR’s inception in 2003 have been left in the dark. PEPFAR’s short-term reauthorization lapsed on March 25, and the U.S. government has not offered the results of PEPFAR’s review or given any guidance on the future of PEPFAR. There are reports of restarting limited life-saving funding for PEPFAR partners, but several partners report being unable to access these funds with the newly stripped-down offices of the government. The recent personnel and budget cuts in key implementing agencies like CDC and USAID call into question whether including PEPFAR funding in the President’s proposed FY26 budget is enough to quell uncertainties about the program’s future. This lack of clear communication leaves partners in a tough position where they do not have the clarity to plan for the future of their programs or the health of their populations. The gospel of Matthew emphasizes the biblical nature of clear communication and integrity with one another.
“But let your ‘yes’ be ‘yes’ and your ‘no’ ‘no’. For whatever is more than these is from the evil one.” — Matthew 5:37
2. From punitive action and termination towards empowerment and transformation
Jesus was calling out the culture and the religious community of his time, when people’s word carried little weight. Jesus calls us to such a high level of integrity and honesty in our relationships that oaths or performative gestures become unnecessary. We are called to live in truthful relationships with one another, and that should include our global partnerships.
Since 2003, the U.S. has invested over $110 billion into the global HIV/AIDS crisis through PEPFAR. Is indiscriminately cutting off funding to countries and programs across the world really the best way for the U.S. to protect its interests? Though PEPFAR is technically under the U.S. State Department, nearly 60% of its bilateral funding was distributed and monitored overseas through USAID. Even though the future of PEPFAR is unclear, key programs funded through PEPFAR and overseen by USAID have already received notices that their programs have been cut. For example, the Elizabeth Glaser Pediatric AIDS Foundation was sent award termination notices affecting HIV treatment programs in Eswatini and Lesotho that affect the medical care of hundreds of thousands of people. The International AIDS Vaccine Initiative (IAVI) was forced to close its ADVANCE program, which has been dedicated to vaccine development and treatment advancements in the HIV epidemic for almost 20 years.
If the goal of PEPFAR was to end the HIV/AIDS epidemic by 2030, how would ending the program five years early be ethically, medically, or financially responsible? In a review on donor transitions in middle-income countries, it was found that global health progress is jeopardized when donor transitions occur too quickly, are not clearly communicated and cannot be planned for. This encompasses areas from critical health infrastructure, healthcare workforce, healthcare financing, and equity of service delivery and availability. Not surprisingly, countries and healthcare programs need time to reallocate internal resources or secure new sources of funding and review how to best deliver services so that medical progress is not lost and lives are not compromised over the long term. Anything less risks reversing years of progress and putting lives at risk.
When evaluating any policy or program, we must consider its impact on the marginalized and the most vulnerable among us. This is not only a key public health principle, but it is also deeply rooted in the core biblical values of compassion, goodness, advocacy, and justice, echoed throughout Scripture. One clear example is in Isaiah 1:17 which says,
“Learn to do good; seek justice, correct oppression; bring justice to the fatherless, and plead the widow’s cause.”
Because PEPFAR is an initiative funding life-saving care for people suffering in the global HIV/AIDS epidemic, it inherently addresses some of the most marginalized among us. Victims of sexual assault, newborns with HIV+ mothers, and men who have sex with men (MSM) are among those at the highest risk. Additionally, these vulnerable groups are more likely to be discriminated against, and the increased stigma experienced by individuals living with HIV can create barriers to care. Through its funding, PEPFAR not only provides critical medical support but also empowers vulnerable communities through HIV education and prevention, care and support for orphans and children affected by HIV, domestic violence prevention, and economic opportunities.
3. From isolation and division towards interconnectedness and unity
A large impact of interrupting PEPFAR funding, or eliminating the initiative entirely is the effect on U.S. national health and on global health. PEPFAR funding has undoubtedly been irreplaceable in fighting the global HIV/AIDS epidemic. However, PEPFAR’s strengths have not been simply in giving money, but rather in creating global health partnerships and programs. PEPFAR’s coalition has been expansive, including civil society organizations, faith-based organizations, and multilateral agencies like UNAIDS and the Global Fund. These partnerships have supported life-saving work in over 55 countries, making the once unrealistic goal of ending the HIV/AIDS epidemic by 2030 now in reach. In addition, countries that are recipients of PEPFAR funding and programming have a higher public opinion of the United States than average. This building of goodwill and trust along with a sense of shared humanity is a key reason why PEPFAR is considered a crucial piece of the U.S.’s strategic national and global security.
If the global sentiment towards PEPFAR is overwhelmingly positive, how do most people feel about it in the United States? A 2023 poll from the Bipartisan Policy Center showed that 82% of voters believed it was important for the U.S. to lead in global health efforts. What’s more, 52% of voters wanted Republicans and Democrats to work together on the United States’ global health efforts against HIV/AIDS. So where is the disconnect between this bipartisan sentiment, the historic impact of PEPFAR, the unpredictability of PEPFAR funding, and the dismantling of USAID? Are we evaluating our policymakers based on our Christian values of compassion, justice, and love? Or are we stuck in political echo chambers that have become more important to our identities than our faith? While concerns about the misuse of U.S. funds for abortions abroad are valid, using those concerns to justify cutting 83% of the United States’ foreign aid contracts is not. PEPFAR’s work has represented the very best of American leadership, not just in terms of medical care and scientific research, but also in its spirit of collaboration and compassion.
A Call for Compassionate Advocacy
James 1:19 says, “Understand this, my dear brothers and sisters: You must all be quick to listen, slow to speak, and slow to get angry.”
This is how Christians should engage with one another, especially across the political aisle and when dealing with important policy issues. While the overarching goal might be like-mindedness, fostering a greater degree of understanding and compassion for one another is a worthy cause. How have we become so hardened to the needs of others that we are apathetic at best, or dismissive at worst, towards the suffering of our fellow human beings?
Dr. Brooke Nichols, an associate professor of Global Health at Boston University, created a PEPFAR Impact Counter to estimate the number of deaths resulting from the freeze and discontinuation of PEPFAR funding. I would like to challenge you to visit that counter and watch those numbers rise: an estimated adult death every 3.3 minutes and an estimated child death every 31 minutes. Those are not just numbers.
Those are fellow men, women, and children, precious image-bearers whose lives matter—each and every one.
Rachel Nygren is currently finishing her MPH, with a concentration in Health Policy and Management. She’s excited to continue exploring the connection between public policy and biblical principles through public health writing. She enjoys sipping iced coffee year-round and spending quality time with loved ones, especially her husband, son and Havanese.
