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.
Once, while presenting my research at a national immunology conference, an attendee asked me why researching human immunodeficiency virus (HIV) matters. I gave a standard response about addressing a major public health crisis. But later, I reflected more deeply on the underlying reasons why I had spent the past three years in Dr. Anding Shen’s HIV research laboratory at Calvin University. I concluded that as a Christ-follower, I am called to restore dignity in places where it had been stripped away. For me, that meant researching the mechanism of HIV infection, understanding the global impact of HIV/AIDS, speaking out against systemic barriers to adequate healthcare, and advocating for policy reform, while approaching the topic of HIV with human-centered compassion.
The Discovery of HIV/AIDS and the Establishment of PEPFAR
Acquired Immune Deficiency Syndrome (AIDS) was first recognized as a new disease in 1981, with June 5 officially marking the beginning of the global AIDS epidemic. According to the Centers for Disease Control and Prevention(CDC), an “epidemic occurs when an agent and susceptible hosts are present in adequate numbers and the agent can be effectively conveyed from a source to the susceptible hosts.” The United Nations reported that over 42.3 million people have died since the beginning of the epidemic. In 1983, scientists discovered that the Human Immunodeficiency Virus (HIV) was the source of AIDS. Since then, there have been numerous attempts at public health initiatives to stop the spread of HIV/AIDS. However, few have remained as successful as the President’s Emergency Plan for AIDS Relief (PEPFAR). Established in 2003 by President George W. Bush, PEPFAR has offered lifesaving antiretroviral medications for over 20 million people, making an unprecedented impact on curtailing the spread of HIV/AIDS. The bill received bipartisan support in both houses of Congress. The Bush White House Records attributed PEPFAR’s success to “U.S. support for local programs that use the power of partnerships among governments, foundations, non-governmental organizations, faith-based groups, and the private sector.”
On January 20, 2025, however, President Trump signed an executive order calling for a 90-day freeze on foreign aid to evaluate whether it aligns with “the foreign policy of the President of the United States.” This decision terminated the contracts of nearly 10,000 global health programs funded by the U.S. Agency for International Development (USAID), including HIV/AIDS initiatives.
At the 2025 Conference on Retroviruses and Opportunistic Infections, hundreds of physicians and researchers submitted a public letter to [Secretary of State] Marco Rubio pleading that PEPFAR funding be restored. The letter argued that “the dismantling of the U.S.-supported AIDS response will cause the deaths of an estimated six million people in the next four years, decades of progress will be reversed, and the world will face growing HIV epidemics across the globe.” At first glance, the prospect of six million deaths is appropriately foreboding. But why is this the likely outcome?
Understanding HIV Treatment and How Disruption Leads to Viral Rebound
The HIV virus targets CD4+ T cells, a type of white blood cell that helps the immune system fight off infections. Currently, with suppressive antiretroviral therapy (ART), HIV can be effectively managed. ART is a type of medication that stops the HIV virus from multiplying. This decreases the amount of HIV virus in someone’s body, giving them time to make additional CD4+ T Cells to fight the virus. The first ART was approved by the Food and Drug Administration (FDA) in March of 1987. It transformed HIV treatment, and since then, ART therapy has continually been revised and improved. Currently, the first line of treatment for HIV is highly active antiretroviral therapy (HAART), which has cut the U.S. AIDS death rate by 70%. The National Institute of Allergy and Infectious Diseases reported that in the 1980s, the average life expectancy following an AIDS diagnosis was approximately one year. Today, if antiretroviral drug treatments are started early in the progression of HIV infection, people living with HIV can expect a near-normal lifespan.
However, even after over 40 years, fully eradicating HIV remains beyond reach due to the presence of latent reservoirs. A latent HIV reservoir is a group of infection-fighting CD4+ T cells that have already been infected with HIV but are not actively producing new virus. The body creates these latent reservoirs during the early stages of HIV infection and harbors the infected immune cells to later use as a last bastion that prevents HIV from being permanently eradicated. Antiretroviral medications can reduce the viral load (amount of virus) in the body. However, they are unable to target and eradicate the virus that is hidden in the viral reservoir.
Today, if antiretroviral drug treatments are started early in the progression of HIV infection, people living with HIV can expect a near-normal lifespan.
If a person with HIV stops their treatment regime, the infected cells within the viral reservoir activate and start producing HIV virus again, leaving scientists unable to achieve long-term viral suppression. Because of these latent reservoirs, cessation of ART, even for 90 days, will prove to be fatal. ART medications are taken in the form of daily pills, or monthly/bimonthly injections. Any interruption in the regimen can lead to viral rebound, medication resistance, transmission of a treatment-resistant virus, and progression to AIDS.
A Christian Response to HIV/AIDS
A proper understanding of HIV treatment underscores the urgency and importance of an active response. Scripture does not permit passive awareness. Rather, it calls the church to seek justice and love mercy by moving beyond theoretical concern into intentional advocacy for the poor and the oppressed. In a world marked by suffering and injustice, Christians are called to stand and fight against systemic barriers and inequalities that disproportionately affect marginalized communities. In the context of HIV/AIDS, this means ensuring that those most vulnerable have access to HIV treatment. Although HIV is increasingly treatable in the West, for those without access to healthcare, a diagnosis of HIV is still synonymous with an imminent death sentence. Our scientific understanding must be paired with a biblical response that challenges systems of inequality. Following Jesus was never about nationalistic interest. It is about identifying with those who are suffering and being moved to the point of action. The Rhode Island Department of Health found that lasting change is accomplished by ensuring access to HIV treatment by addressing “salient social determinants of health including poverty, homelessness, unequal access to healthcare, incarceration, lack of education, stigma, homophobia, sexism, and racism.” The persistence of HIV/AIDS amongst the impoverished, marginalized, orphaned, and oppressed should drive Christians to stand with the affected and speak out with “compassion and mercy amid a profoundly human crisis.”
The Role of Faith-Based Organizations
This call to action has not remained theoretical. It has taken tangible form through the mobilization of civil society, which has played a leading role in the global response to HIV/AIDS. Civil society, including faith-based organizations (FBOs), has long stood with those most affected by global health inequity. While PEPFAR provided crucial governmental funding, much of the hands-on work has been carried out by nongovernmental organizations (NGOs). A 2021 research study that mapped the organizations making up civil society, reported that they seek to, “engage in policy reforms, watch for human rights violations, and advocate against any form of conflict, whether ethnic, religious, or resource-based.” Rayner Tan, from the Saw Swee School of Public Health in Singapore, emphasized that civil society has been a “bridge between policymakers and members of communities that are affected disproportionately by HIV/AIDS.” Additionally, Julia Smith, Faculty of Health Sciences at Simon Fraser University states that civil society seeks to “mobilize communities to demand services, act as service providers, and gather strategic information that inform policies.”
Our scientific understanding must be paired with a biblical response that challenges systems of inequality.
Among civil society, faith-based organizations have played a key role. The 1996 Personal Responsibility and Work Opportunity Reconciliation Act, signed by President Clinton, included the Charitable Choice provision, which allowed faith-based groups to receive government funds without compromising their religious identity. In 1997, the CDC made a concerted effort to include faith-based groups in the global fight against HIV/AIDS by providing technical training to already established FBOs. By the time PEPFAR was announced in 2003, FBOs were already trusted pillars in many communities. A 2017 study of over 100 FBOs found that over 52% had implemented HIV programming in their communities, and 2015 research showed that FBOs provided up to 50% of all health services in sub-Saharan Africa. In 2020, the US Department of State emphasized that these faith communities are still “key for reaching these individuals earlier in their disease progression and providing critical support for continuity of HIV care.” FBOs have accomplished this goal by educating high-risk and highly stigmatized populations, “providing hospice or shelter for people living with HIV,” and promoting living standards that help to prevent the occurrence and limit the spread of illness.
The partnerships between PEPFAR and NGOs have embodied the pursuit of justice by striving to provide equitable healthcare to marginalized populations worldwide. Since 2003, the U.S. government’s Emergency Plan for AIDS Relief has funded and empowered FBOs with the necessary tools to “optimize and highlight targeted HIV testing, offer continuing care, and advance justice for children.” The majority of U.S. global health assistance is channeled through these nongovernmental organizations. By addressing poverty, gender inequality, socioeconomic disparities, and stigmas, FBOs and other organizations offer a trusted, holistic approach to public health by dismantling barriers that prevent individuals from seeking care.
The Future of PEPFAR
The most recent PEPFAR reauthorization was signed in 2024 with bipartisan support, however, the one-year Congressional authorization expired on March 25, 2025. Furthermore, on February 6, 2025, The White House issued a memorandum for the heads of executive departments and agencies directing them to “stop funding NGOs that undermine the national interest.” The Trump administration has not provided further information regarding the halt of funding to global health NGOs, nor the criteria that determine if an NGO does “not align with administration priorities” will be determined.
These enormous cuts to global HIV/AIDS relief programs will have unprecedented effects. Gilead Sciences’ drug, Lenacapavir, was recently accepted by the FDA for priority review. This new drug is a pre-exposure prophylaxis (PrEP) medication given twice yearly and could provide virtually complete protection against HIV infection. PEPFAR was prepared to play a leading role in the distribution of Lenacapavir. Matthew Loftus, a physician and Christian working in Kenya, has emphasized that “damage has already been done. PEPFAR is being dismantled, many people will die as a result. Once clinics have closed, it is difficult to rebuild trust.”
Long-term funding for PEPFAR will ensure continuity and stability for FBOs to continue operations without the uncertainty of ever-fluctuating funding.
To mitigate the effects of recent policy shifts, Congress holds the power to propose a 5-year clean reauthorization. Long-term funding for PEPFAR will ensure continuity and stability for FBOs to continue operations without the uncertainty of ever-fluctuating funding. Anisa Heritage, from the Department of Defense and International Affairs Royal Military Academy, believed that when founded, PEPFAR captured “a unique moment in American political and social life, leading to the largest commitment of any nation to fight one single disease.” Since its inception, the program has “saved tens of millions of lives, transformed the global health landscape, and demonstrated the compassion and leadership of the American people.” This is the time to continue the global fight against HIV/AIDS. By not approving this reauthorization plan, Congress will place millions of lives at risk, and jeopardize the established, trusted relationships that have been built between FBOs and the U.S. Government over the last two decades. The internationally agreed-upon goal was to end the HIV/AIDS epidemic by 2030. A five-year reauthorization would allow PEPFAR to finish the job that it started, and allow the U.S. to “maintain its results-oriented leadership in the global HIV response, a necessary message to combat the rising influence of authoritarian adversaries across the globe.”
Jessica Eddy holds degrees in biochemistry/neuroscience and psychology from Calvin University and has published NIH-funded HIV research in the Journal of Retrovirology under Dr. Anding Shen. When not in the research laboratory, she can be found reading, dancing, rock climbing, or traveling.
