April 23, 2025 • 31 mins
In this episode of One Thing Trump Did, we look at how the Trump administration's sweeping cuts to foreign aid is impacting funding for AIDS relief efforts across the world - especially in sub-Saharan Africa through the PEPFAR program. Jeremy is joined by Jen Kates, Senior Vice President and Director of Global Health & HIV Policy at KFF. #AIDS #PEPFAR #USAID #foreignaid #Trump #Rubio
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Episode Transcript
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Speaker 1 (00:15):
Welcome to One Thing Trump Did, Available exclusively on The
Middle podcast feed.
Speaker 2 (00:19):
I'm Jeremy Hobson.
Speaker 1 (00:21):
Each week on this podcast, we are looking at one
thing coming from the Trump administration, and in a nonpartisan way,
just like on the Middle, we try to learn as
much as we.
Speaker 2 (00:29):
Can about it.
Speaker 1 (00:31):
In this episode, we're looking at one specific element of
an executive order that came at the very beginning of
Trump's term cutting off US foreign aid. One of the
biggest elements of US foreign aid, almost fifteen percent of it,
is funding for AIDS relief. That's because of a program
started under President George W. Bush called PEPFAR, the President's
(00:52):
Emergency Plan for Aids Relief. That program was launched in
two thousand and three and is credited with saving more
than twenty million people's lives by providing HIV medication, but
it was lumped in with all other foreign assistance, which
the Trump administration paused on day one. Here is Secretary
of State Marco Rubio.
Speaker 3 (01:12):
My frustration with USA goes back to my time in Congress.
It's a completely unresponsive agency. It's supposed to respond to
policy directives of the State Department, and it refuses to
do so. So the functions of the USAID. There are
a lot of functions of USAID that are going to
continue that are going to be part of American foreign policy,
but it has to be aligned with American foreign policy.
Speaker 1 (01:33):
After immediate blowback, the White House said pep FAR funding
would continue, but NGOs that receive the money have said
that's not happening. And in addition, PEPFAR's congressional authorization expired
last month. Joining me now is Jen Kates, Senior Vice
president and director of Global Health and HIV Policy at Kffjen.
Speaker 2 (01:54):
Great to have you on, Great to be here.
Speaker 4 (01:56):
Thanks.
Speaker 2 (01:57):
All right, So let's.
Speaker 1 (01:57):
Start with the basics. How does pep FAR work and
what has it done in the last twenty two years?
Speaker 5 (02:03):
Right, So going to the basics and going back to
a time before pep FAR existed, where I've been working
on HIV issues for long enough that I do remember
that time. And that time virtually nobody in Sub Saran
Africa had access to HIV treatments like we did in
the United States at the time, and it meant that
(02:23):
if you got infected with HIV and you lived there
in that part of the world, you almost assuredly died
as you had mentioned, President George W. Bush created pep FAR,
which has it's not overstating it to say that it
has completely changed the trajectory of the epidemic in Sub
Saran Africa and turned around what was going to be
(02:45):
a devastating impact on the continent. The way that it
has worked over the past twenty plus years, since it
had to actually build a lot of the health system
that was needed to deliver HIV drugs, HIV prevention, and
HIV services. It had created a funding system where it
(03:05):
provided grants and contracts to many thousands of implementing organizations NGOs,
private entities, universities, and countries themselves, and through this large
network all over the world began implementing programs from antrotravirals
to like I said, prevention and a whole range of services.
(03:26):
So it really worked through organizations to deliver services and
help to create health infrastructure in countries in about fifty
five countries.
Speaker 1 (03:36):
And when you say antiretrovirals, these are basically medications that
people with HIV would take every day that keeps the
virus undetectable, makes it impossible for them to transmit to
other people. And then when you say prevention. This is
what's called PREP, which can be taken by people who
are HIV negative to keep them that way exactly.
Speaker 5 (03:57):
And PEPFAR did both of those things and did other
things too, which is fund the various aspects of the
healthcare system that are needed to provide anti retroviral therapy
or PREP or other services such as laboratories, supply chains
to make sure that the drugs can get to a country,
that they can get to a clinic, healthcare workers who
(04:18):
can meet with people at risk for HIV or with
HIV and provide them with care as well as you know,
it's not just about drugs, So it provided a range
of services, with i'd say anti retrovirals being the lynchpin
of the constellation of things that it provided and.
Speaker 2 (04:37):
Does all the funding for this come from the United States.
Speaker 4 (04:40):
So when you look at.
Speaker 5 (04:41):
The global HIV epidemic in low and middle income countries,
so in the countries where historically the governments themselves have
not had the budgets to provide treatment and prevention to
people with HIV in their countries, the far majority of
the money that's provided has come from the US government,
(05:02):
and that's either been directly as I described, you know,
providing money to organizations or countries, as well as providing
contributions to international organizations like the Global Fund to Fight AIDS, TB,
and malaria that also work with countries. But if you
put it all together, the far majority of it is
the United States.
Speaker 1 (05:21):
Government, and in the last two decades, the let's say
African countries that get the most out of this program
haven't been able to step in and start paying for
more of it themselves.
Speaker 5 (05:32):
You know, there's evidence and data that show they have,
but just not at the level that could replace what
the US has done. And there's many reasons for that.
You know, there's every reasons, including like economic crisis that
happened in two thousand and eight COVID, which drove down
the global economy, including the economies of those countries. Those
countries owe a lot of debt, and because they owe
(05:54):
a lot of debt, it's been very hard for them
to devote more resources to health. But frankly, the other
reason is that the US government and other donors haven't
really pressured them as much to do that work the historically.
So you put that all together, and there was a
situation where the US was footing most of the bill,
and those countries were either not able to fill in
(06:17):
those you know, fill in much more or just didn't.
Speaker 4 (06:21):
So that was a bit of.
Speaker 5 (06:22):
A challenge, and it had been raised increasingly by Congress
and others.
Speaker 1 (06:28):
Okay, so here's the part of the conversation that as
many articles as I read, I probably won't be able
to figure out the actual answer, and maybe.
Speaker 2 (06:34):
You can help.
Speaker 1 (06:35):
So the State Department says that pepfar is exempt from
the funding pause at USAID, but some people on the
ground are saying that's not the case.
Speaker 2 (06:45):
The money is not flowing. What is going on with
it right now.
Speaker 5 (06:49):
It's a very good question, and the people on the
ground are actually right in a lot of ways. So
what happened was day one of the second Trump administration,
an executive order came out. It said, we are undertaking
a ninety day review of all of our foreign assistants
and as part of that, we're going to stop any
new funds that we have, you know, in our in
(07:10):
our agencies from going out. We want to first decide
do the programs we have align with our interests. Now,
that sounds fine, and in fact was not a huge
surprise since it was recommended by Project twenty twenty five
to do that, but what happened next was not expected.
The administration went on to say, oh, in addition, we
(07:32):
are freezing all current work, So for anyone that we
have already paid or who we owe money to, for
all the clinics that are you know that's that are
staffed by people that we fund, for all the HIV
drugs that are sitting in you know, facilities waiting to
go to clinics, stop all of that work. We're doing
(07:53):
a stock work order. And this wasn't specific to PEPFAR.
They did this virtually for all foreign aid, and they
froze all of the payments and all of the work,
and as you can imagine, that created a very challenging situation.
A few days after that, the Secretary of State Secretary
of Rubio had already announced that they were going to
(08:14):
not freeze anything that was considered humanitarian life saving treatment,
and that became He then applied that to pep FAR
and said for very specific parts of pep FAR, namely
care and treatment mostly, there would not be a freeze.
So it wasn't that all of pep FAR was exempt
(08:35):
from this freeze. Part of pep FAR was exempt, so
that was important. But what also was the case is
by the time that happened, many of the implementers I
talked about, all the implementers had either not gotten information
that they could start work again, or had to lay
off thousands of healthcare workers or close clinics because they
weren't getting paid. So even for let's say a project
(08:59):
that was given a reprieve, many of those projects just
couldn't even do anything anymore, and some still said they
haven't been paid.
Speaker 4 (09:07):
So it is not the case that.
Speaker 5 (09:09):
Every PEPFAR supported care and treatment program around the world
is functioning at this time. Many more are than they were,
but it's not one hundred percent. And in addition, what
they also said is that prevention is not permitted and PREP.
You were talked about PREP before. Part of what they
(09:29):
said was PREP other than for pregnant and breastfeeding women
is no longer permitted. So they really limited what parts
of pep FAR were going to be permitted.
Speaker 1 (09:40):
And has anybody made the case to you of why
they would not want to permit funding for PREP, which
clearly has been very effective.
Speaker 5 (09:49):
Well, I think that their definition of life saving treatment
are mostly services that go to people who already have
HIV and not services that go to people to prevent.
Speaker 4 (10:02):
Them from getting HIV.
Speaker 5 (10:03):
Why that is, you know, I think there from things
I've read and some of the testimonies and hearings that
some members of Congress have held, they think that some
of the behaviors that put people at risk or not
behaviors that should be supported. I mean kind of some
of the views that were from twenty twenty five years
ago or thirty years ago around why people are at
(10:26):
risk for HIV. But in general, I think it's a
much narrower view of what life saving means. Clearly, preventing
somebody from getting HIV in the first place is a
way to save somebody's life. And as you mentioned, PREP
is highly effective. There's also you know, just to stick
with PREP for a second. Just in the last year,
(10:47):
there were two clinical trials that that finish that showed
that a new form of PREP, a very effective injectable
PREP were for twice a year, you could you can
get an injection and it prevent almost all HIV infections,
and the US before the second Trump administration was poised
(11:07):
to make a large purchase of this new prep medication.
As soon as it was approved by the FDA, which
is going to be very soon, it was going to
partner with the Global Fund and purchase it to provide
to two million people at risk, and now that's in jeopardy.
Speaker 1 (11:23):
And separately, by the way, there's a Supreme Court case
right now that involves PREP and whether the Affordable Care
Act should cover it here in the United States.
Speaker 4 (11:30):
Correct.
Speaker 5 (11:31):
That is another issue that's going on with PREP, which is,
I should this advisory committee that exists on the domestic side,
which in the law the ACA, if they give a
certain intervention an A or a B a top rating,
ensures have to cover it for free. And that's been
challenged in court, and so we don't know what's going
(11:52):
to happen with that.
Speaker 1 (11:53):
So just based on what you're hearing, with some of
the funding not getting through, maybe some of it is
continuing to get get through. In Africa right now, are
there people who are you know, just up in arms
outraged because they can't get their medication that they've been getting.
Speaker 5 (12:09):
From what I heard, yes, there are people that are
not getting the medication, and from what I've heard, they're
mostly afraid and and and and unsure about what will
happen next. You know, they have relied on these systems
that have been largely supported by the US and it
was a very abrupt stoppage. So you know, there's some
places where where treatment is flowing and other places where
(12:32):
it's not. And it's very hard to get information about
the immedia, you know, the day to day impacts. Other
than there's been some media reports. There are some NGOs
that are sharing the information because a lot of the
information systems that PEPFAR had were taken down immediately. So
PEFER had a pretty sophisticated information database which you tracked
(12:54):
outcomes in almost real time, and that was taken down
within a couple of days because I think because the
stop work order that I mentioned and the entities that
were funded to run that data system were dismissed, and
there's not personnel really to do it. There's nobody on
the staff on the ground who would have been collecting
(13:17):
the data and providing it are not there or not
able to do that work.
Speaker 1 (13:22):
So there have been calls by some medical professionals and
I think even people from the George W. Bush administration
for like a five year period to transition some of
the funding away from the US government, so it doesn't
just stop like it has in some cases. Are you
hearing is the Trump administration open to something like that?
Speaker 4 (13:42):
Well?
Speaker 5 (13:42):
I think, you know, there is an important context and
backstory here, which is that PEPFAR had for many years
incredibly strong bipartisan support. It was created by a Republican
and it was a program that had support from all corners,
and it was very unusual and for many years it
kind of withstood partisan politics that happens in Washington. You know,
(14:04):
there's always parties in politics, but it kind of stood
outside of that that environment and was able to kind of,
you know, keep going and not get pulled into it.
That began to change, especially during the Binding administration, because
everything was so politicized, but also because there were increasing
calls from members of Congress and particularly Republicans, saying, wait
(14:27):
a minute, We've been funding pep FAR for how many years?
What's the plan for scaling it down? Are we going
to be doing this forever? Should the United States be
doing this forever? Maybe there's you know, an argument to
be made that we have to do a better job
of transitioning this this this work to the countries themselves.
And certainly that was happening or well, that was a
(14:48):
planned but the plans are pretty slow, and it was
not necessarily happening in any you know way that that
you could see that that was progressing. So there was
a growing dissatisfaction I think among some on the hill
that this was just a check that was going to
have to be written forever and there had to be
(15:09):
a different way. So that was the backdrop. I think
though this what has happened in the last couple of months,
this sort of very abrupt end and is not that right.
So I think there's a lot there's discussion about how
can this be done in a more planned way, in
a more thoughtful way that tries to preserve services for
(15:30):
as many people as you can while you work to
scale down. So some have said, yes, there should be
a five year plan. Some have said, you know, you
could start to transition some countries off assistance in the
next two years. But the point being across those ideas,
how can this be done and can it be done
in a way that's a little bit more measured. I
(15:51):
don't know if there's openness in the Trump administration at
this point to do that, but I think as we
near the end of this foreign aid review period.
Speaker 1 (16:01):
I'm speaking with KFF Director of Global Health and HIV.
Speaker 2 (16:05):
Policy, Jen Kates.
Speaker 1 (16:06):
Stay with us. One Thing Trump did will return in
a moment. Welcome back to One Thing Trump Did exclusively
(16:28):
on the Middle Podcast Feed. I'm Jeremy Hobson. This episode,
we're talking about how global AIDS funding from the United
States has been affected by the Trump administration's pause on
foreign aid. I'm joined by Jen Kates, Senior vice president
and director of Global Health and HIV Policy at KFF. Jen,
let's talk about the congressional authorization for PEP far since
(16:49):
the President's executive order that has expired.
Speaker 2 (16:52):
Why did that happen?
Speaker 5 (16:53):
Yeah, So that's a whole other thing that's been going on.
And you know, if we have been talking maybe two
or three months ago, I would have said that the
most important thing to focus on.
Speaker 4 (17:01):
But it's not.
Speaker 5 (17:03):
Meaning that the foreign aid review and freeze is probably
the more urgent. But this is an important thing as well,
and it's very hard to understand, frankly, unless you are
somebody who is in DC and talks about these things
all the time. So I'll try to break it down.
Many programs and departments and agencies in the US government
are created through what's called an authorizing bill. Congress has
(17:28):
committees that are authorizing committees, and those committees pass bills
to create things, to say, we want to create the
National Institutes of Health, we want to create the State Department,
we want to create USAID. These are bills that authorize
the government to stand up something. For example, when PEPFAR
was first created, Congress passed an authorizing bill. Now, the
(17:51):
important thing about authorizing bills is they don't provide the money.
That's what the appropriation appropriators do. So even when you
create a program, you still have to have the other
part of Congress fund it, so they kind of work
in tandem. The other thing about these bills, and I'm
going into, like you know, beyond Schoolhouse Rock this is
we have lots of.
Speaker 4 (18:09):
Detail, but it's important.
Speaker 5 (18:11):
The other thing about authorizing bills is it's really important
what detail they have. Often they'll say, Okay, we're creating
such and such and it's going to end on in
five years, or it's going to end in two years,
or it's going to sunset. But sometimes they don't say
that at all. They create something and it's there forever
pep FAR was created in a sense as permanent part
of US law, it never had an end date. What
(18:34):
is the case, though, is that unless Congress provides money
for it, it can't do anything. So they kind of
go hands in hand. Now what has Remember I mentioned
that PEPFAR has had all this bipartisan support. Well, that
allowed it to be reauthorized every five years, and Congress
would say, yes, let's you know, we're showing our support again,
We're reauthorizing it. And that was good because it showed
(18:57):
that there was support. It allowed Congress to there were
a few provisions in the law that did sunset, so
it allowed Congress to kind of extend them. Congress made
some changes as more was learned. That was all fine
and good. But in the last few years everything has
become so politicized and there have been a lot more
political issues raised about pep FAR, including around abortion, and
(19:20):
we can talk about that. That really stymied the reauthorization process.
So a year ago Congress Republicans in Congress especially could
not agree with Democrats to reauthorize pep FAR, and at
the end of the day, what they decided to do
was to reauthorize it for one year, which they did,
which is unusual usually it was five years. Well, that
(19:42):
just expired, as you mentioned in March twenty fifth, what
does that mean. That means that PEPFAR continues. It was
I think symbolically a bit of a challenge because Congress
was not able to sort of make the statement that
it wanted to reauthorize this program. But the pro doesn't end.
The only practical things that happened where there as I
(20:04):
mentioned a few things in the bill that sunset, meaning
they ended, they're no longer requirements. Congress would have to
do something to make those those continue, but it doesn't
really have a day to day impact on the program.
What has a much bigger impact on the program is
if the administration decides not to spend the money that
(20:25):
Congress is giving to it, which is really doesn't usually happen,
but is happening right now.
Speaker 1 (20:30):
And when you mentioned abortion, this is because I think
there was a clinic or maybe there were more than
one clinic that that that had provided abortions and also
was getting money for pep FAR.
Speaker 4 (20:41):
So yeah, so US law prohibits the use.
Speaker 5 (20:44):
Of federal funds international funds for abortion, and that's been long,
long standing, and that's a that's a very hard line
and not one that that uh PEPFAR has. You know,
PEPFAR has always been very clear about that, as have
foreign aid programs. What happened was that it was discovered
and PEFER has had guidance and all these things, and
(21:05):
there's trainings. What happened is it was discovered that I
think a couple of nurses that were supported by PEPFAR,
their salaries were supported by PEPFAR, had never had the
training and were providing abortion services. That got discovered, it stopped,
and it finally, you know, I think the government paid
back PEPFAR is about four thousand dollars, but it was
(21:25):
a violation. And when that information was brought to the
attention of Congress, this was after the abortion discussion had
happened on the Hill and they were already concerned, they
got even more concerned. And Republican members of Congress in
particular have basically said that they don't try. They weren't
trusting that PEPFAR was not able to manage the situation,
(21:47):
and so that created a real challenge for the program.
Even before the Farnaide freeze was announced. I mean, this
came out just I think a couple weeks before, so,
so that is still there. I think with the having
the Trump administration in place and having reduced the program
significantly at this point, that concern hasn't really surfaced right
(22:08):
now because the program is really just providing mostly care
and treatment right now.
Speaker 1 (22:13):
So we're talking about how this funding helps people, let's say,
in Africa, but in fact, what this funding does is
also prevent drug resistant strains of HIV from coming back
to the United States. If people get taken off their
medication in Africa and then maybe they get on new
medication later, it could be that the HIV in their
(22:36):
bodies develops into a drug resistance strain. Are there worries
about what this could mean for the United States from
a health perspective?
Speaker 4 (22:43):
Definitely.
Speaker 5 (22:44):
I mean you you actually said it exactly the way
people are talk about it in the field, which is
when the US government has spent money on infectious diseases,
whether it's HIV, a bowla TV. Part of the reason
it's done, and of course, is to help people in
poorer countries that aren't able to get the services we get.
But part of the reason it's done is to keep
(23:06):
those diseases at bay and prevent more harmful versions or
prevent spread from coming to the United States. And what
you do the scenario you present, it is not a
far fetched scenario. Treatment is being interrupted in Africa because
of this, and it could lead to drug resistance, which
is a real problem for people with HIV who will
(23:27):
not be able to get medications eventually that could help them.
It could also create the spread of a drug resistant virus.
So all it's hard, I think for an average American
to understand that trying to control infectious diseases in other
countries that they may never go to has an impact
on our lives.
Speaker 4 (23:46):
But it does.
Speaker 5 (23:48):
We just you know, it's like the same thing with
public health. You don't know it's not working until something happens.
Mostly you go about your day and you don't think
about it because the system is working to make to
mitigate that risk.
Speaker 1 (24:01):
Well, and we just saw with COVID how quickly that
something can spread from far away into the United I
was like, within days, every country in the world had
cases of COVID.
Speaker 5 (24:11):
It's true, yeah, And that's you know, and COVID, it
turns out, wasn't even that deadly. It certainly killed a
lot of people, but it's case fatality rate, the rate
at which people who get it die wasn't that high
relative to some other infectious diseases. Imagine if it had been,
or imagine if it was the kind of a virus
that really affected kids the most. I mean, these are
(24:32):
the kinds of scenarios that people that work in infectious
diseases worry about. So part of the rationale for the
US spending funds to help in other countries and to
support our own defense around that is to prevent those
harmful things from happening in the United States.
Speaker 1 (24:51):
From what you've been able to gather, was the freeze
on funding in the case of pep FAR. Was this
an act accident or was this something that somebody in
the Trump administration was actually angling to do, because they
did come out and say, oh no, no, no, it didn't
apply to this. But was it an accident?
Speaker 5 (25:10):
I think there was a genuine, a real intention to
to free to do it review of all furn ad
including pep FAR that was that was definitely purposeful. I
think that not who was making the decisions about freezing
and stopping work and limiting services.
Speaker 4 (25:27):
I don't know where that was totally coming from. I mean,
there were a lot of different forces. Uh. There was
the DOGE team that went in and was doing a
lot of this work.
Speaker 5 (25:38):
There was Secretary of Rubio, there was Peter Morocco, there
was the White House.
Speaker 4 (25:42):
There were a lot of different I think, you know
actors in in this.
Speaker 5 (25:49):
Did they want to stop HIV treatment? I don't think
anyone said let's stop HIV treatment, But I don't know,
you know, I think it was a whole scale furnade
is bad and we're going to stop it, and maybe
not understanding that that would could lead to cutting off
actual medications that people need to stay alive. So I think,
(26:13):
you know, I think it was just part got kind
of caught up in a whole anti furn aid. We
need to review our foreign aid machine process.
Speaker 1 (26:21):
I know there has been some talk about maybe instead
of having it be part of the foreign aid budget,
having some of the funds for pep FAR just come
directly from the CDC look at it in a different way.
Speaker 2 (26:34):
Is that likely?
Speaker 5 (26:35):
That's not really what's being talked about right now, because
the bulk of pep FAR money has always gone to
the State Department that from Congress directly to the State Department.
Speaker 4 (26:45):
The State Department.
Speaker 5 (26:46):
Actually, remember how I said before that the way that
pepfar has worked is through implementers and organizations. The State
Department never does that work. That was always done by
USAID and CDC, So those are like the partners of pepfarencies.
So the money, well, the money is still going to
flow to the State Department, it's just who's going to
implement these programs. Is USAID's gone, CDC is still there.
(27:11):
I think what you might be referring to is on
the domestic side. There was some discussion that the that
the HIV prevention program at CDC for within the US
might be moved to HERSA, which is a domestic health agency.
Speaker 4 (27:25):
But CDC plays let me don't get me wrong.
Speaker 5 (27:28):
CDC plays a really important role in the global HIV response.
It has helped PEPFART implement programs around the world. So
what happens there, you know, is very important.
Speaker 1 (27:39):
To watch well. And CDC is dealing with cuts of
its own because of dose exactly as well. Yes, one
more thing, you know, we played a clip of Marco
Rubio at the top talking about the need for cutting
foreign aid before he was in the administration, he made
the case in public time and again for US foreign aid, saying,
for example, it would be less likely for somebody to
(28:01):
become anti American if their life was saved by the Americans.
What have you learned in your reporting over the years
about the value of pep far just in terms of
America's image in Africa?
Speaker 4 (28:15):
Very good questions.
Speaker 5 (28:16):
So there have been a lot of different studies to
try to understand what kinds of impacts pepfar has had
over time. We've done a number actually in our analysis.
We've done studies that show that PEFER investments have led
to GDP growth rates in Africa, and when Africa African
economies are stronger, they can make better trading partners for
the United States.
Speaker 4 (28:37):
Right.
Speaker 5 (28:38):
We've done studies that show pepfar investments have led to
more kids getting immunized. Pepfar is an immunization program, but
it has created health systems which have benefited kids. So
we've seen a lot of effects of pepfar that are
what we like to say in policy positive, like spillovers. Also,
there have been studies not ours, that have showed that
(29:00):
in countries that get pep FAR money, their views of
the United States have been much better, seeing the United
States as a as a diplomatic and humanitarian partner and
supporting that country in really immeasurable ways. So that's you know,
foreign aid, especially health assistants has one of the reasons
(29:20):
that has always been cited for doing that work is
to help with diplomacy in international partnerships and relationships. And
there's many other reasons, but that is definitely one of them.
Speaker 1 (29:32):
You know. On a personal note, I've been training, training,
doing a lot of bike riding because I'm about to
do my first ever AIDS life cycle, which is the
ride five hundred and forty five miles.
Speaker 2 (29:43):
Oh my gosh, that's a long way from San Francisco
to Los Angeles.
Speaker 1 (29:46):
And this is a bike ride that's been going on
for decades to they say to end AIDS, this is
the last one this year. But part of the reason
for that was that they thought that the world was
getting a handle on the virus. One wonders if now,
because of what's happening, that may not be the case.
Speaker 5 (30:02):
Well, first of all, that's great that you're doing the ride.
I think everyone I know who's done it has had
an amazing experience.
Speaker 4 (30:09):
It's hard, but you can do it. Second.
Speaker 5 (30:11):
Yeah, I mean, I also work on HIV epidemic in
the United States, and there's a lot happening there with
cuts and other potential changes that could really affect the
progress of what we've been able to see in the US.
One thing I'll just say about that in the first
Trump administration, President Trump championed a new initiative called the
(30:32):
Ending the HIV Epidemic Initiative for the US, which was
the first time in years where new funding was provided
across the country to the hardest hit areas, and it
actually it actually worked. New infections went down more in
those areas than others, and it's actually seen as a success.
Speaker 4 (30:51):
Just last week or the week.
Speaker 5 (30:53):
Before, it was leaked in the news that the administration
wanted to cut that program. So we don't know if
that will ultimately happen, but it could happen, and that
could mean that this progress that we've seen might be
stalled or even reversed.
Speaker 1 (31:09):
That is Jen Kates, the senior vice president and director
of Global Health and HIV Policy at KFF.
Speaker 2 (31:14):
Jen, thank you so much for joining us.
Speaker 4 (31:17):
Sure great to be here, and thanks to you.
Speaker 1 (31:19):
For listening to one Thing Trump did. It was produced
by Harrison Patino. Our next middle episode will be in
your podcast feed later this week. We're going to be
talking about the power that billionaires have in our politics.
There are more than a dozen in the Trump administration.
And if you like this podcast, please rate it wherever
you get your podcasts and write a review. Our theme
music was composed by Noah Haidu. I'm Jeremy Hobson. Talk
to you soon.
Welcome to One Thing Trump Did, Available exclusively on The
Middle podcast feed.
Speaker 2 (00:19):
I'm Jeremy Hobson.
Speaker 1 (00:21):
Each week on this podcast, we are looking at one
thing coming from the Trump administration, and in a nonpartisan way,
just like on the Middle, we try to learn as
much as we.
Speaker 2 (00:29):
Can about it.
Speaker 1 (00:31):
In this episode, we're looking at one specific element of
an executive order that came at the very beginning of
Trump's term cutting off US foreign aid. One of the
biggest elements of US foreign aid, almost fifteen percent of it,
is funding for AIDS relief. That's because of a program
started under President George W. Bush called PEPFAR, the President's
(00:52):
Emergency Plan for Aids Relief. That program was launched in
two thousand and three and is credited with saving more
than twenty million people's lives by providing HIV medication, but
it was lumped in with all other foreign assistance, which
the Trump administration paused on day one. Here is Secretary
of State Marco Rubio.
Speaker 3 (01:12):
My frustration with USA goes back to my time in Congress.
It's a completely unresponsive agency. It's supposed to respond to
policy directives of the State Department, and it refuses to
do so. So the functions of the USAID. There are
a lot of functions of USAID that are going to
continue that are going to be part of American foreign policy,
but it has to be aligned with American foreign policy.
Speaker 1 (01:33):
After immediate blowback, the White House said pep FAR funding
would continue, but NGOs that receive the money have said
that's not happening. And in addition, PEPFAR's congressional authorization expired
last month. Joining me now is Jen Kates, Senior Vice
president and director of Global Health and HIV Policy at Kffjen.
Speaker 2 (01:54):
Great to have you on, Great to be here.
Speaker 4 (01:56):
Thanks.
Speaker 2 (01:57):
All right, So let's.
Speaker 1 (01:57):
Start with the basics. How does pep FAR work and
what has it done in the last twenty two years?
Speaker 5 (02:03):
Right, So going to the basics and going back to
a time before pep FAR existed, where I've been working
on HIV issues for long enough that I do remember
that time. And that time virtually nobody in Sub Saran
Africa had access to HIV treatments like we did in
the United States at the time, and it meant that
(02:23):
if you got infected with HIV and you lived there
in that part of the world, you almost assuredly died
as you had mentioned, President George W. Bush created pep FAR,
which has it's not overstating it to say that it
has completely changed the trajectory of the epidemic in Sub
Saran Africa and turned around what was going to be
(02:45):
a devastating impact on the continent. The way that it
has worked over the past twenty plus years, since it
had to actually build a lot of the health system
that was needed to deliver HIV drugs, HIV prevention, and
HIV services. It had created a funding system where it
(03:05):
provided grants and contracts to many thousands of implementing organizations NGOs,
private entities, universities, and countries themselves, and through this large
network all over the world began implementing programs from antrotravirals
to like I said, prevention and a whole range of services.
(03:26):
So it really worked through organizations to deliver services and
help to create health infrastructure in countries in about fifty
five countries.
Speaker 1 (03:36):
And when you say antiretrovirals, these are basically medications that
people with HIV would take every day that keeps the
virus undetectable, makes it impossible for them to transmit to
other people. And then when you say prevention. This is
what's called PREP, which can be taken by people who
are HIV negative to keep them that way exactly.
Speaker 5 (03:57):
And PEPFAR did both of those things and did other
things too, which is fund the various aspects of the
healthcare system that are needed to provide anti retroviral therapy
or PREP or other services such as laboratories, supply chains
to make sure that the drugs can get to a country,
that they can get to a clinic, healthcare workers who
(04:18):
can meet with people at risk for HIV or with
HIV and provide them with care as well as you know,
it's not just about drugs, So it provided a range
of services, with i'd say anti retrovirals being the lynchpin
of the constellation of things that it provided and.
Speaker 2 (04:37):
Does all the funding for this come from the United States.
Speaker 4 (04:40):
So when you look at.
Speaker 5 (04:41):
The global HIV epidemic in low and middle income countries,
so in the countries where historically the governments themselves have
not had the budgets to provide treatment and prevention to
people with HIV in their countries, the far majority of
the money that's provided has come from the US government,
(05:02):
and that's either been directly as I described, you know,
providing money to organizations or countries, as well as providing
contributions to international organizations like the Global Fund to Fight AIDS, TB,
and malaria that also work with countries. But if you
put it all together, the far majority of it is
the United States.
Speaker 1 (05:21):
Government, and in the last two decades, the let's say
African countries that get the most out of this program
haven't been able to step in and start paying for
more of it themselves.
Speaker 5 (05:32):
You know, there's evidence and data that show they have,
but just not at the level that could replace what
the US has done. And there's many reasons for that.
You know, there's every reasons, including like economic crisis that
happened in two thousand and eight COVID, which drove down
the global economy, including the economies of those countries. Those
countries owe a lot of debt, and because they owe
(05:54):
a lot of debt, it's been very hard for them
to devote more resources to health. But frankly, the other
reason is that the US government and other donors haven't
really pressured them as much to do that work the historically.
So you put that all together, and there was a
situation where the US was footing most of the bill,
and those countries were either not able to fill in
(06:17):
those you know, fill in much more or just didn't.
Speaker 4 (06:21):
So that was a bit of.
Speaker 5 (06:22):
A challenge, and it had been raised increasingly by Congress
and others.
Speaker 1 (06:28):
Okay, so here's the part of the conversation that as
many articles as I read, I probably won't be able
to figure out the actual answer, and maybe.
Speaker 2 (06:34):
You can help.
Speaker 1 (06:35):
So the State Department says that pepfar is exempt from
the funding pause at USAID, but some people on the
ground are saying that's not the case.
Speaker 2 (06:45):
The money is not flowing. What is going on with
it right now.
Speaker 5 (06:49):
It's a very good question, and the people on the
ground are actually right in a lot of ways. So
what happened was day one of the second Trump administration,
an executive order came out. It said, we are undertaking
a ninety day review of all of our foreign assistants
and as part of that, we're going to stop any
new funds that we have, you know, in our in
(07:10):
our agencies from going out. We want to first decide
do the programs we have align with our interests. Now,
that sounds fine, and in fact was not a huge
surprise since it was recommended by Project twenty twenty five
to do that, but what happened next was not expected.
The administration went on to say, oh, in addition, we
(07:32):
are freezing all current work, So for anyone that we
have already paid or who we owe money to, for
all the clinics that are you know that's that are
staffed by people that we fund, for all the HIV
drugs that are sitting in you know, facilities waiting to
go to clinics, stop all of that work. We're doing
(07:53):
a stock work order. And this wasn't specific to PEPFAR.
They did this virtually for all foreign aid, and they
froze all of the payments and all of the work,
and as you can imagine, that created a very challenging situation.
A few days after that, the Secretary of State Secretary
of Rubio had already announced that they were going to
(08:14):
not freeze anything that was considered humanitarian life saving treatment,
and that became He then applied that to pep FAR
and said for very specific parts of pep FAR, namely
care and treatment mostly, there would not be a freeze.
So it wasn't that all of pep FAR was exempt
(08:35):
from this freeze. Part of pep FAR was exempt, so
that was important. But what also was the case is
by the time that happened, many of the implementers I
talked about, all the implementers had either not gotten information
that they could start work again, or had to lay
off thousands of healthcare workers or close clinics because they
weren't getting paid. So even for let's say a project
(08:59):
that was given a reprieve, many of those projects just
couldn't even do anything anymore, and some still said they
haven't been paid.
Speaker 4 (09:07):
So it is not the case that.
Speaker 5 (09:09):
Every PEPFAR supported care and treatment program around the world
is functioning at this time. Many more are than they were,
but it's not one hundred percent. And in addition, what
they also said is that prevention is not permitted and PREP.
You were talked about PREP before. Part of what they
(09:29):
said was PREP other than for pregnant and breastfeeding women
is no longer permitted. So they really limited what parts
of pep FAR were going to be permitted.
Speaker 1 (09:40):
And has anybody made the case to you of why
they would not want to permit funding for PREP, which
clearly has been very effective.
Speaker 5 (09:49):
Well, I think that their definition of life saving treatment
are mostly services that go to people who already have
HIV and not services that go to people to prevent.
Speaker 4 (10:02):
Them from getting HIV.
Speaker 5 (10:03):
Why that is, you know, I think there from things
I've read and some of the testimonies and hearings that
some members of Congress have held, they think that some
of the behaviors that put people at risk or not
behaviors that should be supported. I mean kind of some
of the views that were from twenty twenty five years
ago or thirty years ago around why people are at
(10:26):
risk for HIV. But in general, I think it's a
much narrower view of what life saving means. Clearly, preventing
somebody from getting HIV in the first place is a
way to save somebody's life. And as you mentioned, PREP
is highly effective. There's also you know, just to stick
with PREP for a second. Just in the last year,
(10:47):
there were two clinical trials that that finish that showed
that a new form of PREP, a very effective injectable
PREP were for twice a year, you could you can
get an injection and it prevent almost all HIV infections,
and the US before the second Trump administration was poised
(11:07):
to make a large purchase of this new prep medication.
As soon as it was approved by the FDA, which
is going to be very soon, it was going to
partner with the Global Fund and purchase it to provide
to two million people at risk, and now that's in jeopardy.
Speaker 1 (11:23):
And separately, by the way, there's a Supreme Court case
right now that involves PREP and whether the Affordable Care
Act should cover it here in the United States.
Speaker 4 (11:30):
Correct.
Speaker 5 (11:31):
That is another issue that's going on with PREP, which is,
I should this advisory committee that exists on the domestic side,
which in the law the ACA, if they give a
certain intervention an A or a B a top rating,
ensures have to cover it for free. And that's been
challenged in court, and so we don't know what's going
(11:52):
to happen with that.
Speaker 1 (11:53):
So just based on what you're hearing, with some of
the funding not getting through, maybe some of it is
continuing to get get through. In Africa right now, are
there people who are you know, just up in arms
outraged because they can't get their medication that they've been getting.
Speaker 5 (12:09):
From what I heard, yes, there are people that are
not getting the medication, and from what I've heard, they're
mostly afraid and and and and unsure about what will
happen next. You know, they have relied on these systems
that have been largely supported by the US and it
was a very abrupt stoppage. So you know, there's some
places where where treatment is flowing and other places where
(12:32):
it's not. And it's very hard to get information about
the immedia, you know, the day to day impacts. Other
than there's been some media reports. There are some NGOs
that are sharing the information because a lot of the
information systems that PEPFAR had were taken down immediately. So
PEFER had a pretty sophisticated information database which you tracked
(12:54):
outcomes in almost real time, and that was taken down
within a couple of days because I think because the
stop work order that I mentioned and the entities that
were funded to run that data system were dismissed, and
there's not personnel really to do it. There's nobody on
the staff on the ground who would have been collecting
(13:17):
the data and providing it are not there or not
able to do that work.
Speaker 1 (13:22):
So there have been calls by some medical professionals and
I think even people from the George W. Bush administration
for like a five year period to transition some of
the funding away from the US government, so it doesn't
just stop like it has in some cases. Are you
hearing is the Trump administration open to something like that?
Speaker 4 (13:42):
Well?
Speaker 5 (13:42):
I think, you know, there is an important context and
backstory here, which is that PEPFAR had for many years
incredibly strong bipartisan support. It was created by a Republican
and it was a program that had support from all corners,
and it was very unusual and for many years it
kind of withstood partisan politics that happens in Washington. You know,
(14:04):
there's always parties in politics, but it kind of stood
outside of that that environment and was able to kind of,
you know, keep going and not get pulled into it.
That began to change, especially during the Binding administration, because
everything was so politicized, but also because there were increasing
calls from members of Congress and particularly Republicans, saying, wait
(14:27):
a minute, We've been funding pep FAR for how many years?
What's the plan for scaling it down? Are we going
to be doing this forever? Should the United States be
doing this forever? Maybe there's you know, an argument to
be made that we have to do a better job
of transitioning this this this work to the countries themselves.
And certainly that was happening or well, that was a
(14:48):
planned but the plans are pretty slow, and it was
not necessarily happening in any you know way that that
you could see that that was progressing. So there was
a growing dissatisfaction I think among some on the hill
that this was just a check that was going to
have to be written forever and there had to be
(15:09):
a different way. So that was the backdrop. I think
though this what has happened in the last couple of months,
this sort of very abrupt end and is not that right.
So I think there's a lot there's discussion about how
can this be done in a more planned way, in
a more thoughtful way that tries to preserve services for
(15:30):
as many people as you can while you work to
scale down. So some have said, yes, there should be
a five year plan. Some have said, you know, you
could start to transition some countries off assistance in the
next two years. But the point being across those ideas,
how can this be done and can it be done
in a way that's a little bit more measured. I
(15:51):
don't know if there's openness in the Trump administration at
this point to do that, but I think as we
near the end of this foreign aid review period.
Speaker 1 (16:01):
I'm speaking with KFF Director of Global Health and HIV.
Speaker 2 (16:05):
Policy, Jen Kates.
Speaker 1 (16:06):
Stay with us. One Thing Trump did will return in
a moment. Welcome back to One Thing Trump Did exclusively
(16:28):
on the Middle Podcast Feed. I'm Jeremy Hobson. This episode,
we're talking about how global AIDS funding from the United
States has been affected by the Trump administration's pause on
foreign aid. I'm joined by Jen Kates, Senior vice president
and director of Global Health and HIV Policy at KFF. Jen,
let's talk about the congressional authorization for PEP far since
(16:49):
the President's executive order that has expired.
Speaker 2 (16:52):
Why did that happen?
Speaker 5 (16:53):
Yeah, So that's a whole other thing that's been going on.
And you know, if we have been talking maybe two
or three months ago, I would have said that the
most important thing to focus on.
Speaker 4 (17:01):
But it's not.
Speaker 5 (17:03):
Meaning that the foreign aid review and freeze is probably
the more urgent. But this is an important thing as well,
and it's very hard to understand, frankly, unless you are
somebody who is in DC and talks about these things
all the time. So I'll try to break it down.
Many programs and departments and agencies in the US government
are created through what's called an authorizing bill. Congress has
(17:28):
committees that are authorizing committees, and those committees pass bills
to create things, to say, we want to create the
National Institutes of Health, we want to create the State Department,
we want to create USAID. These are bills that authorize
the government to stand up something. For example, when PEPFAR
was first created, Congress passed an authorizing bill. Now, the
(17:51):
important thing about authorizing bills is they don't provide the money.
That's what the appropriation appropriators do. So even when you
create a program, you still have to have the other
part of Congress fund it, so they kind of work
in tandem. The other thing about these bills, and I'm
going into, like you know, beyond Schoolhouse Rock this is
we have lots of.
Speaker 4 (18:09):
Detail, but it's important.
Speaker 5 (18:11):
The other thing about authorizing bills is it's really important
what detail they have. Often they'll say, Okay, we're creating
such and such and it's going to end on in
five years, or it's going to end in two years,
or it's going to sunset. But sometimes they don't say
that at all. They create something and it's there forever
pep FAR was created in a sense as permanent part
of US law, it never had an end date. What
(18:34):
is the case, though, is that unless Congress provides money
for it, it can't do anything. So they kind of
go hands in hand. Now what has Remember I mentioned
that PEPFAR has had all this bipartisan support. Well, that
allowed it to be reauthorized every five years, and Congress
would say, yes, let's you know, we're showing our support again,
We're reauthorizing it. And that was good because it showed
(18:57):
that there was support. It allowed Congress to there were
a few provisions in the law that did sunset, so
it allowed Congress to kind of extend them. Congress made
some changes as more was learned. That was all fine
and good. But in the last few years everything has
become so politicized and there have been a lot more
political issues raised about pep FAR, including around abortion, and
(19:20):
we can talk about that. That really stymied the reauthorization process.
So a year ago Congress Republicans in Congress especially could
not agree with Democrats to reauthorize pep FAR, and at
the end of the day, what they decided to do
was to reauthorize it for one year, which they did,
which is unusual usually it was five years. Well, that
(19:42):
just expired, as you mentioned in March twenty fifth, what
does that mean. That means that PEPFAR continues. It was
I think symbolically a bit of a challenge because Congress
was not able to sort of make the statement that
it wanted to reauthorize this program. But the pro doesn't end.
The only practical things that happened where there as I
(20:04):
mentioned a few things in the bill that sunset, meaning
they ended, they're no longer requirements. Congress would have to
do something to make those those continue, but it doesn't
really have a day to day impact on the program.
What has a much bigger impact on the program is
if the administration decides not to spend the money that
(20:25):
Congress is giving to it, which is really doesn't usually happen,
but is happening right now.
Speaker 1 (20:30):
And when you mentioned abortion, this is because I think
there was a clinic or maybe there were more than
one clinic that that that had provided abortions and also
was getting money for pep FAR.
Speaker 4 (20:41):
So yeah, so US law prohibits the use.
Speaker 5 (20:44):
Of federal funds international funds for abortion, and that's been long,
long standing, and that's a that's a very hard line
and not one that that uh PEPFAR has. You know,
PEPFAR has always been very clear about that, as have
foreign aid programs. What happened was that it was discovered
and PEFER has had guidance and all these things, and
(21:05):
there's trainings. What happened is it was discovered that I
think a couple of nurses that were supported by PEPFAR,
their salaries were supported by PEPFAR, had never had the
training and were providing abortion services. That got discovered, it stopped,
and it finally, you know, I think the government paid
back PEPFAR is about four thousand dollars, but it was
(21:25):
a violation. And when that information was brought to the
attention of Congress, this was after the abortion discussion had
happened on the Hill and they were already concerned, they
got even more concerned. And Republican members of Congress in
particular have basically said that they don't try. They weren't
trusting that PEPFAR was not able to manage the situation,
(21:47):
and so that created a real challenge for the program.
Even before the Farnaide freeze was announced. I mean, this
came out just I think a couple weeks before, so,
so that is still there. I think with the having
the Trump administration in place and having reduced the program
significantly at this point, that concern hasn't really surfaced right
(22:08):
now because the program is really just providing mostly care
and treatment right now.
Speaker 1 (22:13):
So we're talking about how this funding helps people, let's say,
in Africa, but in fact, what this funding does is
also prevent drug resistant strains of HIV from coming back
to the United States. If people get taken off their
medication in Africa and then maybe they get on new
medication later, it could be that the HIV in their
(22:36):
bodies develops into a drug resistance strain. Are there worries
about what this could mean for the United States from
a health perspective?
Speaker 4 (22:43):
Definitely.
Speaker 5 (22:44):
I mean you you actually said it exactly the way
people are talk about it in the field, which is
when the US government has spent money on infectious diseases,
whether it's HIV, a bowla TV. Part of the reason
it's done, and of course, is to help people in
poorer countries that aren't able to get the services we get.
But part of the reason it's done is to keep
(23:06):
those diseases at bay and prevent more harmful versions or
prevent spread from coming to the United States. And what
you do the scenario you present, it is not a
far fetched scenario. Treatment is being interrupted in Africa because
of this, and it could lead to drug resistance, which
is a real problem for people with HIV who will
(23:27):
not be able to get medications eventually that could help them.
It could also create the spread of a drug resistant virus.
So all it's hard, I think for an average American
to understand that trying to control infectious diseases in other
countries that they may never go to has an impact
on our lives.
Speaker 4 (23:46):
But it does.
Speaker 5 (23:48):
We just you know, it's like the same thing with
public health. You don't know it's not working until something happens.
Mostly you go about your day and you don't think
about it because the system is working to make to
mitigate that risk.
Speaker 1 (24:01):
Well, and we just saw with COVID how quickly that
something can spread from far away into the United I
was like, within days, every country in the world had
cases of COVID.
Speaker 5 (24:11):
It's true, yeah, And that's you know, and COVID, it
turns out, wasn't even that deadly. It certainly killed a
lot of people, but it's case fatality rate, the rate
at which people who get it die wasn't that high
relative to some other infectious diseases. Imagine if it had been,
or imagine if it was the kind of a virus
that really affected kids the most. I mean, these are
(24:32):
the kinds of scenarios that people that work in infectious
diseases worry about. So part of the rationale for the
US spending funds to help in other countries and to
support our own defense around that is to prevent those
harmful things from happening in the United States.
Speaker 1 (24:51):
From what you've been able to gather, was the freeze
on funding in the case of pep FAR. Was this
an act accident or was this something that somebody in
the Trump administration was actually angling to do, because they
did come out and say, oh no, no, no, it didn't
apply to this. But was it an accident?
Speaker 5 (25:10):
I think there was a genuine, a real intention to
to free to do it review of all furn ad
including pep FAR that was that was definitely purposeful. I
think that not who was making the decisions about freezing
and stopping work and limiting services.
Speaker 4 (25:27):
I don't know where that was totally coming from. I mean,
there were a lot of different forces. Uh. There was
the DOGE team that went in and was doing a
lot of this work.
Speaker 5 (25:38):
There was Secretary of Rubio, there was Peter Morocco, there
was the White House.
Speaker 4 (25:42):
There were a lot of different I think, you know
actors in in this.
Speaker 5 (25:49):
Did they want to stop HIV treatment? I don't think
anyone said let's stop HIV treatment, But I don't know,
you know, I think it was a whole scale furnade
is bad and we're going to stop it, and maybe
not understanding that that would could lead to cutting off
actual medications that people need to stay alive. So I think,
(26:13):
you know, I think it was just part got kind
of caught up in a whole anti furn aid. We
need to review our foreign aid machine process.
Speaker 1 (26:21):
I know there has been some talk about maybe instead
of having it be part of the foreign aid budget,
having some of the funds for pep FAR just come
directly from the CDC look at it in a different way.
Speaker 2 (26:34):
Is that likely?
Speaker 5 (26:35):
That's not really what's being talked about right now, because
the bulk of pep FAR money has always gone to
the State Department that from Congress directly to the State Department.
Speaker 4 (26:45):
The State Department.
Speaker 5 (26:46):
Actually, remember how I said before that the way that
pepfar has worked is through implementers and organizations. The State
Department never does that work. That was always done by
USAID and CDC, So those are like the partners of pepfarencies.
So the money, well, the money is still going to
flow to the State Department, it's just who's going to
implement these programs. Is USAID's gone, CDC is still there.
(27:11):
I think what you might be referring to is on
the domestic side. There was some discussion that the that
the HIV prevention program at CDC for within the US
might be moved to HERSA, which is a domestic health agency.
Speaker 4 (27:25):
But CDC plays let me don't get me wrong.
Speaker 5 (27:28):
CDC plays a really important role in the global HIV response.
It has helped PEPFART implement programs around the world. So
what happens there, you know, is very important.
Speaker 1 (27:39):
To watch well. And CDC is dealing with cuts of
its own because of dose exactly as well. Yes, one
more thing, you know, we played a clip of Marco
Rubio at the top talking about the need for cutting
foreign aid before he was in the administration, he made
the case in public time and again for US foreign aid, saying,
for example, it would be less likely for somebody to
(28:01):
become anti American if their life was saved by the Americans.
What have you learned in your reporting over the years
about the value of pep far just in terms of
America's image in Africa?
Speaker 4 (28:15):
Very good questions.
Speaker 5 (28:16):
So there have been a lot of different studies to
try to understand what kinds of impacts pepfar has had
over time. We've done a number actually in our analysis.
We've done studies that show that PEFER investments have led
to GDP growth rates in Africa, and when Africa African
economies are stronger, they can make better trading partners for
the United States.
Speaker 4 (28:37):
Right.
Speaker 5 (28:38):
We've done studies that show pepfar investments have led to
more kids getting immunized. Pepfar is an immunization program, but
it has created health systems which have benefited kids. So
we've seen a lot of effects of pepfar that are
what we like to say in policy positive, like spillovers. Also,
there have been studies not ours, that have showed that
(29:00):
in countries that get pep FAR money, their views of
the United States have been much better, seeing the United
States as a as a diplomatic and humanitarian partner and
supporting that country in really immeasurable ways. So that's you know,
foreign aid, especially health assistants has one of the reasons
(29:20):
that has always been cited for doing that work is
to help with diplomacy in international partnerships and relationships. And
there's many other reasons, but that is definitely one of them.
Speaker 1 (29:32):
You know. On a personal note, I've been training, training,
doing a lot of bike riding because I'm about to
do my first ever AIDS life cycle, which is the
ride five hundred and forty five miles.
Speaker 2 (29:43):
Oh my gosh, that's a long way from San Francisco
to Los Angeles.
Speaker 1 (29:46):
And this is a bike ride that's been going on
for decades to they say to end AIDS, this is
the last one this year. But part of the reason
for that was that they thought that the world was
getting a handle on the virus. One wonders if now,
because of what's happening, that may not be the case.
Speaker 5 (30:02):
Well, first of all, that's great that you're doing the ride.
I think everyone I know who's done it has had
an amazing experience.
Speaker 4 (30:09):
It's hard, but you can do it. Second.
Speaker 5 (30:11):
Yeah, I mean, I also work on HIV epidemic in
the United States, and there's a lot happening there with
cuts and other potential changes that could really affect the
progress of what we've been able to see in the US.
One thing I'll just say about that in the first
Trump administration, President Trump championed a new initiative called the
(30:32):
Ending the HIV Epidemic Initiative for the US, which was
the first time in years where new funding was provided
across the country to the hardest hit areas, and it
actually it actually worked. New infections went down more in
those areas than others, and it's actually seen as a success.
Speaker 4 (30:51):
Just last week or the week.
Speaker 5 (30:53):
Before, it was leaked in the news that the administration
wanted to cut that program. So we don't know if
that will ultimately happen, but it could happen, and that
could mean that this progress that we've seen might be
stalled or even reversed.
Speaker 1 (31:09):
That is Jen Kates, the senior vice president and director
of Global Health and HIV Policy at KFF.
Speaker 2 (31:14):
Jen, thank you so much for joining us.
Speaker 4 (31:17):
Sure great to be here, and thanks to you.
Speaker 1 (31:19):
For listening to one Thing Trump did. It was produced
by Harrison Patino. Our next middle episode will be in
your podcast feed later this week. We're going to be
talking about the power that billionaires have in our politics.
There are more than a dozen in the Trump administration.
And if you like this podcast, please rate it wherever
you get your podcasts and write a review. Our theme
music was composed by Noah Haidu. I'm Jeremy Hobson. Talk
to you soon.
Host
Jeremy Hobson
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