# The Upcoming PEPFAR Cut Will Kill Millions, Many of Them Children


Crossposted from [my blog](https://benthams.substack.com/p/the-upcoming-pepfar-cut-will-kill).  

(This could end up being the most important thing I’ve ever written. Please like and restack it—if you have a big blog, please write about it).

A mother holds her sick baby to her chest. She knows he doesn’t have long to live. She hears him coughing—those body-wracking coughs—that expel mucus and phlegm, leaving him desperately gasping for air. He is just a few months old. And yet that’s how old he will be when he dies.

The aforementioned scene is likely to become increasingly common in the coming years. Fortunately, there is still hope.

Trump recently signed an executive order shutting off almost all foreign aid. Most terrifyingly, this included shutting off the PEPFAR program—the single most successful foreign aid program in my lifetime. PEPFAR provides treatment and prevention of HIV and AIDS—it has saved about [25 million people](https://www.state.gov/results-and-impact-pepfar#:~:text=PEPFAR%20has%20enabled%205.5%20million,to%20mothers%20living%20with%20HIV.) since its implementation in 2001, despite only taking less than 0.1% of the federal budget. Every [single day that it is operative](https://www.amfar.org/press-releases/trump-administrations-order-requiring-immediate-suspension-of-all-hiv-services-provided-by-pepfar-will-place-lives-at-risk/), PEPFAR supports:

> *   More than 222,000 people on treatment in the program collecting ARVs to stay healthy;
> *   More than 224,000 HIV tests, newly diagnosing 4,374 people with HIV – 10% of whom are pregnant women attending antenatal clinic visits;
> *   Services for 17,695 orphans and vulnerable children impacted by HIV;
> *   7,163 cervical cancer screenings, newly diagnosing 363 women with cervical cancer or pre-cancerous lesions, and treating 324 women with positive cervical cancer results;
> *   Care and support for 3,618 women experiencing gender-based violence, including 779 women who experienced sexual violence.

The most important thing PEPFAR does is provide life-saving anti-retroviral treatments to [millions of victims of HIV](https://www.state.gov/results-and-impact-pepfar). More than [20 million people living](https://www.state.gov/results-and-impact-pepfar) with HIV globally depend on daily anti-retrovirals, including over half a million children. These children, facing a deadly illness in desperately poor countries, are now going to be left on their own, and a lot of them are going to die.

Imagine a baby you care about having to face that. Imagine them having a horrible disease, a disease that will likely kill them if untreated. But they have been getting treatment—treatment that makes it so that they will not die from the disease but be able to grow and flourish. Now, with the stroke of a pen, their medicine will be cut off—probably they will die in a few months. [Kelsey Piper writes](https://x.com/KelseyTuoc/status/1883601122524537144):

> There are five hundred thousand kids who PEPFAR provides HIV drugs that keep their immune system working. AIDS kills babies very quickly if they aren't on antivirals. Two to six months, which is also about when most babies with SCID die. It's about how long you can make it in this world without an immune system.
> 
> \[Context: Kelsey’s baby has a cold\].
> 
> I've spent a lot of time yesterday and today in the shower - the hot steam helps the baby - cradling her to my chest while she whimpers "why, why, why?" and knowing that she will be completely fine. The world where this cold could have killed her feels like it is terribly nearby. The children that immunodeficiencies do kill don't feel very far away, either.

Earlier I said PEPFAR has saved 25 million people. In fact, the 25 million people saved number is probably an underestimate. It doesn’t take into account that PEPFAR [has built up infrastructure](https://www.vox.com/future-perfect/24036223/pepfar-aids-hiv-africa-global-health-george-w-bush-republicans-congress) in poor countries that makes it easier for them to combat other diseases. As a result, the little-known PEPFAR program is probably the single most effective federal program per dollar. A temporary pause in PEPFAR means a temporary pause in providing life-saving medicine—it means a lot of people will die. Many of those will be vulnerable children.

About half a million people died in the Iraq war. The PEPFAR program saved about 50 times that number of people. A program might be gutted that saved enough lives to offset the Iraq war 50 times over. The end of PEPFAR will kill, in a year, more people than died during the entire Iraq war. PEPFAR was responsible for kicking the crap out of AIDS in Africa, for making it so that the number of victims of AIDS over time looked like this:

![Image](https://substackcdn.com/image/fetch/w_1456,c_limit,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Fa52c2702-3ce2-476b-ac37-1fa0b6fabc8b_680x480.jpeg)

Fortunately, the end of PEPFAR is not inevitable. Rubio kept up [famine relief](https://www.aljazeera.com/news/2025/1/25/us-suspends-new-funds-for-aid-programmes-excepting-israel-and-egypt) and military aid to Morocco and Israel. With the stroke of a pen, Trump or Rubio could do the same for PEPFAR. If either Trump or Rubio wanted to, they could make sure PEPFAR relief continues. Neither has any special reason to be opposed to PEPFAR—the program is traditionally bipartisan! The only reason they’re cutting it is likely that they haven’t heard about it.

So let’s get the word out! The PEPFAR cut is unpopular; it can only thrive in the darkness. Help make it a national issue so that people know what PEPFAR does. Honestly, if Rubio just read one article about PEPFAR, I think he could be talked into keeping up the program rather than cutting it. Time is of the essence—the longer PEPFAR is cut, the more people—many of them children—will die.

Being against kids dying isn’t a partisan issue. Help make sure that no mothers have to clutch their sick babies to their chest, knowing that they have only weeks to live, because of an executive order’s collateral damage. Rather than surrendering, let’s win the war against this wretched disease—this killer of children. No more babies need to die of this scourge, this plague that we could wipe out if we put in the effort—as we’ve been doing for decades. If Trump takes pivotal action on AIDS, he could be one of the only people in history to successfully eradicate a disease!

The stakes are high—I cannot describe just how horrible it is that many children might die because of this, but hopefully this poem from a grieving mother can help [show some of the seriousness](https://newmercymoms.com/blog/loss-of-child-poem-collection) of this issue. If PEPFAR is cut, she will not be the only mother to grieve a dead child.

*In fields where once you played and ran,*  
*Where first you walked, my little man,*  
*I see your footprints in the sand,*  
*And feel the warmth of your small hand.*

*Your first steps wobbly, yet so brave,*  
*The joy of learning, waves you gave,*  
*To ride a bike, your laughter free,*  
*Each memory, now bittersweet to me.*

*The mud beneath the summer rain,*  
*You splashed and played, forgot the pain,*  
*Catching bugs in the hot sun's glow,*  
*Your spirit bright, your heart aglow.*

*We built a snowman in the yard,*  
*And shared a bond, so true, so hard,*  
*But now those moments turn to dust,*  
*As grief engulfs, as memories rust.*

*The years we had, I'm thankful for,*  
*Yet sorrow knocks at every door,*  
*For now your life on earth is done,*  
*Your journey ceased, my precious son.*

*I did not see your end draw near,*  
*And guilt, it whispers in my ear,*  
*I should have known, I should have seen,*  
*The shadows fall where light had been.*

*Your goodbye letter in my hand,*  
*A testament to dreams unplanned,*  
*I long to tell you, one last time,*  
*How much you're loved, my dear, sublime.*

*You're needed here, your laugh, your light,*  
*Your absence turns my days to night,*  
*So many questions, answers few,*  
*The pain so deep, I can't construe.*

(If you want to do something to help stop PEPFAR cuts, share this article and as other sources about PEPFAR’s importance as widely as you can, especially if you know someone who might be influential on this issue. Additionally, contact your local congresspeople and donate to [other charities helping save children from disease](https://www.givewell.org/charities/top-charities)!)