I have often been wary of the argument that foreign aid is merely a form of charity or that it is money that is not expended wisely. Some forms of foreign aid do fall into that category, but programs like The President’s Emergency Plan for AIDS Relief (PEPFAR) are one of the clearest cases where international assistance can have a significant, positive impact. PEPFAR was established under President George W. Bush in 2003 to address the HIV/AIDS epidemic, and it has been credited with saving approximately 26 million lives since its establishment.

While this program enjoys bipartisan support, it runs the risk of weakening because of the withholding of funds that Congress has already appropriated for this program. I argue that this is a mistake and that any aim to transition it must require a balanced, gradual, and effective approach.  

An Investment In Global Health & Soft Power

PEPFAR is not merely a charity, but rather a form of strategic generosity aimed at improving global health security, to the benefit of the world and Americans who live at home and abroad. PEPFAR is not only a program that saves millions of lives, but it also helps America buy influence abroad, especially in developing countries.

For example, PEPFAR achieved “outsized returns” in global health security and improved relations with recipient countries. For example, under the program, the costs of antiretroviral treatment (ART) in low-income target countries fell from $1,200 per person to just $60 after the first two decades since the program’s inception. In terms of influence, according to a report by the Bipartisan Policy Center, African nations which got aid under PEPFAR have the strongest support of American leadership versus countries that received little to no support. 

The logic makes sense and follows the evidence; when you make one of the largest single-disease investments to curb it, there is going to be a significant impact on those nations that suffer most from it. And those nations, seeing America’s role in improving their health, are also likely to see America in a more positive light.

This investment, however, exists in the context of a larger geopolitical game. China has made its own health investments in Africa, with the aim of gaining influence in the region. And while their move has created controversy, China has been effective at gaining a foothold. For example, according to a 2023 Gallup poll, China’s approval rating in Africa beat that of the U.S., 58% versus 56%, respectively. This illustrates the competing forces at play in Africa. Whereas China is making its own investments via the Belt and Road Initiative, America uses programs like PEPFAR to compete. 

In other words, while the humanitarian case for PEPFAR should be sufficient, the program enjoys bipartisan support – even at a time when foreign aid is being cut – because choosing to pull back risks ceding space to one of America’s main geopolitical rivals. 

A Reasonable Goal Pursued Recklessly

The Trump Administration, however, is pursuing changes to PEPFAR under the America First Global Health Strategy. The idea is that money would be given directly to governments, rather than external implementers. However, the Administration’s own report claims that it “cut overall spending by 30 percent while preserving critical frontline HIV care”. This sounds good on paper, but the reality is that much of the funds provided for the programs are not being used.

Furthermore, Global AIDS Policy Partnership (GAPP) casts doubt on the State Department’s claim that it can cut funds while still keeping treatment levels stable. For example, an analysis by GAPP shows that “PEPFAR-supported testing in Q4 2025 dropped to 17.2 million from 21.9 million during the same period in 2024, a decline of nearly 17% across the full year”. This data is corroborated by an additional report by the Center for Global Development. 

Additionally, the healthcare workforce under PEPFAR declined by 24% from Fiscal Year 2024 to Fiscal Year 2025. On top of this, millions of orphans, vulnerable children, and young women lost access to the program after the cuts that were implemented in 2025. One review notes that officials frame this disruption under the guise of “creative destruction”, but this argument misses the fact that a more graduated approach, with a well-funded core, could have mitigated these negative effects. 

Simply put, the withholding of PEPFAR funds during any reform process will only lead to a lower level of reach and efficacy within the program. Indeed, country ownership for these funds is a legitimate and perhaps even a desirable change. The error, however, is in the abrupt way these reforms are being pursued.

The Way Forward

The withholding of funds overrides Congress’s clear bipartisan will. The Trump Administration should release the appropriated funds and run PEPFAR efficiently and fully while pursuing its reforms in a graduated manner. Any change to existing programming requires time, and time must be given to ensure that the core of the program does not suffer. Congress had already appropriated $6 billion to PEPFAR while rejecting $400 million in cuts to the program under the President’s budget request, illustrating that the bipartisan consensus in our legislative body agrees with my argument. Both Republicans and Democrats understand that PEPFAR not only saves lives, but it is a key tool in America’s arsenal to counter China’s growing influence in Africa. 

I am not arguing that reforming PEPFAR is not worthwhile, as direct contracts with recipient nations can serve American foreign policy interests even better than how PEPFAR was originally designed. However, we can do so while ensuring that PEPFAR, a program that saves millions of lives, enhances American influence abroad, and protects global health security, must be well-funded and implemented during that transition.