An Evangelical mission doctor has warned that millions of lives are at stake surrounding the potential dismantling of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), as country music artists led by Amy Grant have called for the program’s reauthorization.
PEPFAR, launched in 2003 under President George W. Bush, is the largest global health initiative focused on a single disease, HIV/AIDS. PEPFAR has sent over $100 billion to more than 50 countries in the last two decades, providing antiretroviral therapy (ARVs) life-saving treatment and infrastructure support to regions most affected by the epidemic, particularly in Africa.
However, recent aid cuts and reductions to global health funding by the Trump administration and logistical disruptions have jeopardized the delivery of these essential services, leaving 20 million people reliant on PEPFAR-supported medications at risk. The initiative depends on logistical support from the U.S. Agency for International Development.
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Additionally, the law that established PEPFAR will expire on Tuesday.
Dr. Matthew Loftus, an Evangelical physician working at a Presbyterian mission hospital in Kenya, expressed grave concerns about the impact of these disruptions.
“Many people will die,” he recently told The Guardian, pointing to reports of patients unable to access ARVs or being forced to pay for them.
“In some places they’re not getting the drugs or they’re being asked to pay cash for the drugs,” Loftus detailed. “Other places are completely closed and so patients are scrambling to find medications or they’re going without.”
The doctor stressed that “there are going to be consequences.” In some areas, clinics have shut down entirely, leaving patients scrambling for alternatives. Loftus warned that treatment interruptions could lead to drug resistance.
“Once you stop taking ARVs, within days, the virus can come back online and then start developing resistance,” he said. “I’m really scared that there are going to be a bunch of people who haven’t been taking their drugs and then, when we try to start them back, we’re going to find that they’re resistant. They could turn everything back on tomorrow, and I think there would be permanent damage. Once you fire people and close clinics, rebuilding trust is difficult; getting people to come back is difficult.”
The PEPFAR program has historically received bipartisan support and backing from Evangelical organizations and leaders like the National Association of Evangelicals, Pastor Rick Warren, World Vision the Faith & Freedom Coalition. Evangelicals also played a crucial role in lobbying for PEPFAR’s creation in 2003.
Galen Carey, vice president of government relations at the National Association of Evangelicals (NAE), told the outlet that “PEPFAR has been a very popular bipartisan program,” noting that it has become entangled in larger foreign aid debates.
Faith-based organizations, such as World Relief, the humanitarian arm of the National Association of Evangelicals, have been at the forefront of PEPFAR’s efforts since its inception.
Emily Chambers Sharpe, health director at World Relief, said the program’s success in delivering ARVs has been life-changing.
“When Pepfar was up for reauthorization we, as World Relief, have supported it every time. We see it as really overarchingly a pro-life program in that it promotes the life-saving need for HIV treatment, which many of us in the field have called The Lazarus Effect,” she told The Guardian.
Clinics supported by the program often serve as critical healthcare hubs, addressing also other medical needs in underserved regions. In Nigeria, for example, PEPFAR accounts for nearly all HIV funding, and its collapse could reverse decades of progress.
“When you get someone on antiretroviral therapy, you see them literally be able to come back to life,” Sharpe said. “And now we know if you’re on antiretroviral therapy, you can even prevent the spread of the virus to others so it’s not just life-saving for you, it can be life-saving for loads of other people.”
The United Nations claimed in February that if PEPFAR is not re-authorized, there could be a 400% increase in AIDS deaths between 2025 and 2029.
“That’s 6.3 million people, 6.3 million AIDS related deaths that will occur in the future,” Christine Stegling, deputy executive director of UNAIDS, said at a press briefing last month.
Led by Christian contemporary singer Amy Grant and the ONE Campaign, several popular country artists have signed onto a letter sent to Congress last week urging the full funding of PEPFAR. Other signatories of the letter are Brad Paisley, Darius Rucker, LeAnn Rimes and Sheryl Crow among others.
“If Congress decides to cut funding for PEPFAR, people will not receive their medication. The virus will rebound. Infections will multiply. Millions will die,” the letter states, noting that, thanks to the program, “we are on track to end the AIDS epidemic status by 2030.”
“Today, twenty million people are on antiretroviral medications, keeping infection and death rates at their lowest in twenty years,” the statement asserted. “That’s twenty million souls for whom ‘America’ means generosity, compassion and life. But all that can change in the blink of an eye. If Congress decides to cut funding for PEPFAR, people will not receive their medication. The virus will rebound. Infections will multiply. Millions will die. And, the epidemic will grow exponentially worldwide, including a potential explosion in our own backyards.”
Even during the Biden administration, PEPFAR’s future came under scrutiny amid partisan debates over whether the program is funding abortion providers, a claim denied by Democrats. Some pro-life legislators raised concerns, questioning whether the program was directly or indirectly involved in providing or promoting abortion services and other “radical” ideologies.
In May 2023 report, the conservative think tank the Heritage Foundation claimed that “the Biden Administration has misused the program as a well-funded vehicle to promote its domestic radical social agenda overseas, as it has done with other foreign aid programs.”
“PEPFAR should be restructured as a development program rather than emergency assistance and should move toward more country ownership and co-financing,” the report states.
When PEPFAR was first established, Republicans pushed for the program to promote abstinence and education. But abstinence has since been “stripped” from the program and “Democrats have now added — in a practice decried by locals as neocolonialism — their own social priorities like abortion and promotion of LGBTI issues,” the report claims.
Speaking on the floor of the U.S. House of Representatives in September 2023, Rep. Chris Smith, R-N.J., stated that Biden’s PEPFAR implementation strategy instituted in 2022, “Reimagining PEPFAR’s Strategic Direction,” integrated “sexual and reproductive health and rights — including abortion — with HIV/AIDs work.”
“The idea of integrating the killing of unborn children by abortion with HIV/AIDs programs isn’t original. The World Health Organization, UN Population Fund, the International Planned Parenthood Federation, and others, have all been aggressively pushing an identical integration strategy for years,” Smith said. “The Biden plan instructs pro-abortion non-governmental organizations receiving PEPFAR funds to change laws and policies on abortion in PEPFAR targeted countries.”
Myal Greene, the president and CEO of World Relief, wrote an op-ed for The Hill at the time that her organization had “never seen any hint that any funds are being unlawfully used to promote abortion.” She implored lawmakers and pro-life Evangelicals to “continue supporting this fundamental pro-life program instead of allowing unfounded allegations to disrupt a program that has preserved millions of lives.”
“In World Relief’s work, it would be unthinkable for us to ever engage in promoting abortion. This behavior would not only go against how we understand what Scripture commands, but it would also be illegal — under U.S. law and under the laws of most of the sovereign African nations where World Relief operates. Many other faith-based PEPFAR grantees also share similar convictions,” Greene wrote.
“Even among PEPFAR grantees that may not share the same convictions, we’ve never seen any hint that any funds are being unlawfully used to promote abortion. Congress has established safeguards to ensure that organizations only use PEPFAR or other USAID funds for their prescribed purpose, which explicitly excludes abortion or the promotion of abortion, and all grant recipients are required to undergo training on these legal restrictions.”
