Christian evangelical organizations instrumental in creating the US program that has saved millions of lives from HIV/Aids are pressing the Trump administration to rescue the scheme from crushing cuts to foreign assistance.
The state department has said that the two-decade-old President’s Emergency Plan for Aids Relief (Pepfar), which is estimated to have prevented 25m early deaths, is exempt from the cancellation of most US overseas aid. But the program is heavily reliant on logistical support from the US Agency for International Development (USAid), which has seen most of its projects killed off.
Evangelical groups, many of which backed Trump’s election because of abortion policy, say delivery of anti-retroviral medicines (ARVs) funded by the US has all but ground to a halt in some countries, particularly in Africa. They warn that could lead to a resurgence of Aids in parts of the world where it has been brought under control, costing millions of lives.
But other evangelical organizations and churches have been accused of staying silent in defense of what has been described as one of the most successful foreign aid programs in US history for political reasons because so many of their members support Trump.
Emily Chambers Sharpe, health director at World Relief, the humanitarian arm of the National Association of Evangelicals, said that healthcare centers and hospitals in different parts of Africa report that “the supply chain for HIV as a whole has been very badly damaged” by the aid cuts.
“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 said.
“When you get someone on antiretroviral therapy, you see them literally be able to come back to life. 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.”
Chambers Sharpe criticised what she called a “lack of transparency” within the state department about cuts to USAid and its impact on Pepfar.
Galen Carey, vice-president of government relations at the National Association of Evangelicals (NAE), which has backed some of Trump’s policies while also criticizing its harsh treatment of refugees as unChristian, called on the administration to save Pepfar before it is too late.
“We’re encouraging the administration to get the program back up to full speed as soon as possible,” he said.
Carey said “there’s quite a bit of concern in Congress because Pepfar has been a very popular bipartisan program” but he added that it has been caught up in the broader assault on foreign aid.
About 20 million people are reliant on medicines supplied by Pepfar mostly in Africa and parts of Asia. Some countries, such as Nigeria, depend on Pepfar for almost all their HIV funding. Others are less reliant but Pepfar still provides crucial health infrastructure because its clinics frequently employ medical staff who treat other conditions as part of the broader programme of combatting Aids.
Matthew Loftus, a doctor and evangelical Christian working at a mission hospital in Kenya, said the damage was already being done on the ground. He said that Pepfar “is being dismantled” and that “many people will die” as a result.
“In some places they’re not getting the drugs or they’re being asked to pay cash for the drugs. Other places are completely closed and so patients are scrambling to find medications or they’re going without,” he said.
“There are going to be consequences. Once you stop taking ARVs, within days the virus can come back online and then start developing resistance. 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.”
Evangelical Christian groups were instrumental in persuading President George W Bush to launch Pepfar in 2004. Carey said churches saw it not only as a pro-life position but an opportunity to promote their values.
“When I first went to Africa in 1997, an HIV-positive diagnosis was basically a death sentence. It was devastating. Many pastors spent much of their time conducting funerals. Driving along main roads in Kenya you would see shop after shop selling coffins,” he said.
“Over time, it really turned around in a dramatic way. The stories that came out of caring for orphans and helping local churches and promoting Christian understanding of sexual morality and faithfulness in marriage was an important piece of the puzzle since a lot of the transmission was through sexual contact. It fitted in with our broader concerns, both pro-life and pro-family.”
A change of heart by the acerbic segregationist senator, Jesse Helms, brought on a lot of conservative support by shifting the US narrative around Aids away from sexual morality.
In 2003, the rock star Bono told Helms that Aids had created 10 million orphans in Africa and that the lives of newborn babies could be saved by a single dose of a medicine that limited the transmission of HIV from mother to child. Helms was persuaded that Aids relief was a pro-life position and opened the door to congressional support for Pepfar.
Loftus has seen the impact of the programme on the ground in Kenya.
“Most HIV-positive patients I see are patients whose viral load is completely suppressed and they are coming to the hospital for a different problem. When I do see someone who dies of HIV-related illness, it’s just another tragedy because now it’s completely preventable,” he said.
“I hear stories from older missionaries. They talk about wards full of people with Aids, dying all the time. That’s part of the fear looking ahead. If these programmes don’t survive, what are we going to go back to?”
The call to save Pepfar has been joined by a range of religious groups, including the National Latino Evangelical Coalition. But Loftus said that, as an evangelical, he was concerned that many churches are not speaking up in support of the initiative, even though they have in the past, because it would mean criticising Trump.
“People I talk to are aggrieved about this. It is challenging the way that churches follow political trends rather than the other way around,” he said.
“Some churches are not as eager to put their necks out and advocate for something that seems to be opposed by some of the people in power. I think churches and Christians who are politically active are not aware of what’s at stake, and many of them are probably consuming news in an environment that isn’t even bringing it up as an issue. But I think also that there is this conflict now between our convictions versus who’s in charge and who do we want to please?”
