In 2006, Ambassador Mark Dybul, then the United States global AIDS coordinator, visited an orphanage run by the Daughters of Charity in Ethiopia. It was a sanctuary for more than 400 HIV-positive babies and young children found in garbage heaps, abandoned on the roadside, or left at the orphanage door. As Dybul and Michael Gerson, then a senior policy adviser to President George W. Bush, walked through the massive campus, they came to the dining hall, where they saw a mural of Jesus surrounded by a group of children. The sisters told them that the mural featured portraits of children who had died of HIV at the orphanage, and that the children came there to talk to and play with their friends on the wall.
The epidemic was hardly confined to Ethiopia. It was ravaging sub-Saharan Africa. Two-thirds of the 40 million people in the world infected with HIV lived in that region. More than 12 million children had been orphaned by AIDS.
In parts of Botswana, 75 percent of pregnant women had HIV. Most diseases kill the very old and the very young, “but this disease was killing the most productive and reproductive parts of society,” Dybul recalled in 2018. “So not only were many households run by orphans, but entire villages were run by orphans, because everyone else was dead.”
Then came PEPFAR.
The President’s Emergency Plan for AIDS Relief, first authorized by Bush in 2003, was the largest commitment made by any nation to address a single disease. It was, the president said, “a work of mercy beyond all current international efforts to help the people of Africa.” PEPFAR, which received strong bipartisan support, is credited with saving 26 million lives and enabling almost 8 million babies to be born without HIV. It transformed the landscape of the HIV epidemic and helped stabilize the African continent. Not only is PEPFAR the single most successful policy to date in U.S.-Africa relations; it is “also one of the most successful foreign policy programs in U.S. history,” as Belinda Archibong, a fellow at the Brookings Institution, wrote last year.
“The dying stopped after PEPFAR,” Margrethe Juncker, a Danish doctor who cared for urban slum dwellers living with HIV/AIDS in Uganda and who treated Engole, told Nakkazi. She called the program a “miracle.”
Then came Donald Trump.
On the first day of his second term, Trump issued Executive Order 14169, calling for a 90-day pause on all foreign-development and assistance programs pending further review. A subsequent stop-work order froze payments and work already under way, hobbling programs worldwide. The administration dissolved USAID, the main U.S. organization that provides humanitarian aid and the primary implementing agency for PEPFAR.
The stop-work order initially froze all PEPFAR programming and services, halting work in the field, including the provision of antiretroviral therapy. And although PEPFAR—which accounts for 0.08 percent of the federal budget and has been consistently judged to be a highly effective and accountable program—received a limited waiver in February allowing it to continue “life-saving HIV services,” the actual implementation of that waiver has been delayed, fragmented, and chaotic. Supply chains have been disrupted; so have diagnostic and treatment services. There have been mass layoffs of staff. Clinics have been shut down. “The result was unprecedented operational chaos, funding lapses, the collapse of implementation partnerships, and, in many cases, clinic closures,” according to the Center for Strategic and International Studies. Those on the ground report widespread disruption of HIV services and devastating consequences for PEPFAR beneficiaries; the infrastructure that took years to build has been decimated. That will remain true even if the Trump administration were to reactivate PEPFAR tomorrow.
More than 75,000 adults and children are now estimated to have died because of the effective shutdown of PEPFAR that began less than six months ago. Another adult life is being lost every three minutes; a child dies every 31 minutes. Ending PEPFAR could result in as many as 11 million additional new HIV infections and nearly 3 million additional AIDS-related deaths by the end of the decade.
Once PEPFAR was announced, a number of evangelical groups and individuals played an important role in supporting it. They understood their faith to call them to care for the sick and the poor, to advocate for the oppressed, and to demonstrate their commitment to the sanctity of life. But as this human catastrophe unfolds, few American evangelical pastors, churches, denominations, or para-church organizations have spoken out against the destruction of PEPFAR. Nor, from what I can tell, do they seem inclined to do so.
Why have so many evangelicals remained silent? . . . . Chris Davis, of Groveton Baptist Church in Alexandria, Virginia, and a strong supporter of PEPFAR, told me that for many, the issue seems distant. “Very few evangelicals have walked down Coffin Row in Malawi or know anyone who has,” he said. . . . Scott Dudley, of Bellevue Presbyterian Church in Bellevue, Washington, believes the destruction of PEPFAR is a tragedy, but his church is preoccupied with other unfolding changes. “The main reason we haven’t addressed PEPFAR,” he told me, “is because we are more involved with issues around refugees, asylum seekers, and immigration. Our partners in this are Christian nonprofits who lost huge amounts of money in the cuts to USAID.”
Some ministers, instead, cited an aversion to becoming involved in politics, especially politics that might roil a congregation. Many Christians believe that church is meant for worship, not for guidance on policy, even on pressing humanitarian issues.
A principled aversion to politicizing the pulpit was sometimes difficult to distinguish from a very human fear of speaking out on issues that might trigger an angry response from Trump supporters in the pews. Even pastors whose moral conscience might make them inclined to speak out against the decimation of PEPFAR think twice about doing so, because they don’t want to become the target of attacks by members of their own congregation.
He’s hardly alone. “Any pastor who has ever ventured to speak out on a controversial ‘political’ issue, whether it’s a moral issue or not, knows that he will get tremendous, angry feedback from some of his people,” a man who had pastored an influential evangelical church in Northern Virginia told me.
“There is a general suspicion of government programs and an assumption that anything run by the government is characterized by inefficiencies and graft,” he told me. “So the slashing of governmental programs rarely causes an outcry among evangelicals.”
A person who was once involved in ministry described the mindset this way: “The government shouldn’t be doing this. Even if PEPFAR is a great program and saves millions of lives, it’s not the role of the U.S. government to spend the money obtained from the forcible confiscation of citizens’ property for the benefit of non-Americans.
A minister in a church in Memphis told me it’s important to “recall that most evangelicals also originally viewed the HIV/AIDS issue as a result of sexual promiscuity, and gay promiscuity especially. So I suspect too many of them regard the HIV/AIDS crisis as a self-inflicted contagion. I can imagine the moralists saying, ‘They brought this on themselves. It’s God’s judgment on them for their sexual sin. And they shouldn’t expect me to pay for their meds.’”
“The judgment that it was either a gay disease or the result of extramarital promiscuity fed evangelicals’ resistance and disinterest,” Dearborn told me. Despite its efforts to focus evangelicals on saving millions in Africa from dying of AIDS, World Vision had difficulty making inroads. “It’s never been a priority, even though women and children are often innocent victims who suffer and die from the disease,” he said.
But it’s still hard to ignore this fact: White evangelicals voted in overwhelming numbers to put into office a president who has, for now, decimated a program that qualifies as among the greatest health interventions in the history of medicine and one of the most humanitarian acts in the history of America. Millions may die as a result. And a religious movement that proudly advertises itself as pro-life, and which over the years has taken public stands on issues including abortion, same-sex marriage, pornography, critical race theory, the role of women in combat, school curriculum, and sports betting and gambling in all forms, has, with rare exceptions, said nothing about it.
A pastor of a conservative evangelical church told me he’s grieved by this. “I got exhausted by the sympathetic inaction,” he told me. “If a Democratic administration were doing this—callously, illegally, and completely unnecessarily destroying a cause prayed for, advocated for, designed by, and in many cases carried out by evangelical believers—I struggle to believe that the response would be any less immediate and strident than if they were to mandate states to permit abortion.” He added, “The gleeful destruction of USAID and careless discarding of lives, and the associated lies, are such obvious crossings of red lines, such blatant violations of a basic Christian posture in the world, that acting as though they are politics as usual actively deceives and disempowers our people, and we will have to deal with the cost of inaction as the projections become historical fact.”
“White churches and congregations seem tone-deaf to the raw pain and suffering so many are experiencing,” he told me. “When the social location of our gospel allows us to not see, to not hear, or to not care for vulnerable people, we fail the way of Jesus.” What gospel, he asked, are we prepared to live?
The award-winning Christian singer-songwriter Amy Grant performed last month along with fellow evangelical musicians at a church in Brentwood, Tennessee, to raise awareness of and support for PEPFAR. “I look at the conservative faith community and the word pro-life is said many times, and I go, ‘Whoa, there’s not much more of a pro-life effort than combatting HIV/AIDS worldwide,’” Grant said.
Davis is grieved by the sheer cruelty of abandoning PEPFAR. “It does almost nothing to address our national debt, it does nothing to transfer these lifesaving programs to other funding sources, and costs a potential of millions of lives per year,” he said. “To what end? For what great cause? This is the exact disregard for human life that animates our anger against abortion. So why are we not furious at this catastrophic loss of life?”
People who have become “culture warriors” in the name of Jesus often validate their cultural politics by proof-texting the Bible. But proof-texting the Bible can lead to some very bad places, as we’ve seen throughout Christian history, when verses from the Bible were used to justify everything from genocide to wars, from anti-Semitism to slavery and segregation, from geo-centrism to attacks on evolution. In Luke 4, we’re told that Satan used the Bible—Psalm 91—to tempt Jesus, in what is surely the most prominent of the great proof-texting wars.
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