US global AIDS programme is under threat

Many people don’t realise the devastation wrought by the AIDS pandemic in sub-Saharan Africa. By 2003, 30 million Africans were infected with HIV, yet only 50 000 were receiving antiretroviral therapy (ART).1 For the rest, AIDS remained a death sentence.

Life expectancy fell by more than a decade in many countries in the region, and dropped below 45 years in Swaziland (now Eswatini) and Zambia.2 HIV/AIDS orphaned millions of children and forced parents to remove children (particularly girls) from school. The pandemic hollowed out workforces and unravelled economies, fostering conditions ripe for violence, unrest, and instability. Health systems were collapsing and health workers were dying. In 2000, US President Bill Clinton formally declared AIDS a national security threat that could topple governments, trigger ethnic wars, and dismantle free market democracies.3

Then in 2003, President George W Bush—a strongly antiabortion Republican—established the President’s Emergency Plan for AIDS Relief (PEPFAR). PEPFAR is the largest commitment …