DOGE and Trump Threaten AIDS Program That ‘Kept a Generation Alive’

Steve Hoyt didn’t go to the Amecet children’s home in Soroti, Uganda, looking for a child to adopt. The missionary, engineer, and father of two went to the home for orphaned and abandoned children run by the Christian organization Youth With A Mission, to check on a child as a favor for an employee. While he was there, he noticed a baby — he guessed she was about 18 months old — languishing despite the care of the nurses.

She wasn’t as young as she looked, they told him. She was 3 years old, and she was dying of AIDS. Both of her parents had died of the disease, and most of the staff, who “nursed children to heaven” regularly, expected that the toddler who never toddled would soon follow them. Hoyt formed a bond with the little girl, and when he went home, told his wife Melinda, “If she’s alive when you go visit in three weeks, we should adopt her.”

The little girl was not only alive, but thriving when Melinda Hoyt met her in 2006, blossoming under the care of the Amecet nurses, funded by the President’s Emergency Plan for AIDS Relief, better known as PEPFAR. The baby was living proof of what’s called “the Lazarus effect” of antiretroviral medication — changing a person’s immediate future from death to life.

Nearly 20 years later, the success of programs like PEPFAR and other foreign aid are under attack from the Trump administration, Elon Musk, and the Department of Government Efficiency. The one-year reauthorization passed in 2024 expired in March. The program is funded through September, but the only certainty for PEPFAR’s future seems to be uncertainty and a likely cut to funding. 

Life-giving programs and an American promise

The Hoyts would spend the next decade taking their daughter, whose name is being withheld at the Hoyt’s request to protect her privacy, to another PEPFAR clinic closer to their home. At first they visited once per month, and then, as the girl’s viral load decreased, once every three months. She would be tested, receive her antiretroviral medication, and any other therapy needed surrounded by dozens of other children doing the same, Melinda Hoyt remembers. “It was all free. It was amazing and beautiful.”

Not only were they surrounded by children surviving what used to be a death sentence, the Hoyts remember that many of the doctors, clinicians, and even one of the judges in their adoption case were all living with HIV. They were following the same protocols as their patients, standing as testimony to hope for an adulthood that was relatively new.

“PEPFAR kept a generation alive that would have died,” Melinda said.

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When the missionary family returned home on sabbatical, the doctors at the clinic worked with them to secure a year’s worth of the medication, because the cost in the U.S. would have been $12,000 per year in the mid-2000s. Thanks to PEPFAR-funded medication, Melinda said, their daughter has been able to get to know her adoptive grandparents and extended family on trips to the U.S. “We have lived such an amazing life because of this program.”

The little girl is grown now, having lived long past the life expectancy for a Ugandan child with HIV in 2006. She moved to the U.S. with the Hoyts when they returned for medical furlough and is now enrolled in college and working. She still takes her antiretroviral medication every day, now paid for through the Affordable Care Act. Every year of their daughter’s life has been made possible by a commitment from the people of the U.S., Melinda said.

“We really thought she wasn’t going to make it to adulthood. We were counting on the government to keep its word,” she said.

Musk and Trump slash foreign aid

For the past 22 years, the U.S. invested over $100 billion into PEPFAR, saving the lives of over 25 million people affected by HIV and AIDS. The “Lazarus effect” was raising entire communities from their deathbeds.

But since the inauguration of the second Trump administration, PEPFAR-funded clinics, doctors, and hospitals have been in a constant state of uncertainty. In some cases, they’ve seen an abrupt end to their funding, as Musk’s DOGE dismantles foreign aid programs.

Musk and Trump claim that DOGE is seeking to cut government waste. They’ve fired thousands of federal employees, including in the U.S. Agency for International Development and the State Department agency that oversees PEPFAR. The State Department has granted a waiver to AIDS-relief programs and other “life-saving humanitarian assistance,” but clinics, hospitals, and nonprofits around the world say that funding has not been restored.

Brent Phillips, CEO of Cherish Uganda, a medical ministry in a small village outside Entebbe, said his ministry is one of several working to navigate the unpredictability.

“We’re just praying that stuff gets worked out before we run out [of antiretroviral medications],” Phillips said.

Cherish receives antiretroviral drugs from PEPFAR partners in Uganda and administers them to around 200 of their 800 patients per month. When the freeze was announced, he said, they immediately began to stockpile what they could, but supplies are running out. Each patient requires a different cocktail of medicines, and while some ingredients still have a six-month supply, he said, some components of the prescriptions are already used up. The first to go: the syrup given to infants. The doctors at Cherish have been reconstituting adult medicines to create their own syrup for the babies, he said, but eventually that supply will run out too.

The ripple effect

Even if funds start flowing again, he said, supply chain disruptions have already caused harm. Patients take their antiretroviral medication daily. Any lapse in availability or clinic closures has an effect, even if it’s temporary.

“Once you come off those meds, even for a day, the viral load spikes,” Phillips said. It’s not as though Cherish can go out and replace the medicines out of pocket either. The cost of one month of medication for their 200 HIV patients would be around $800,000 to purchase on the private market. “This isn’t fixed by, ‘Let’s just raise some more money,’” Phillips said.

The disruption is also harming the trust these rural aid networks depend on. The team at Cherish has to work with patients to emphasize how important it is that they never, ever miss a day, he said. Now, when the patients show up, often having traveled a long way for their monthly appointment, the clinic is having to tell them that they don’t have the medication they need, and the trust begins to erode immediately.

“For the first time ever, they show up and we don’t have it … funding and supply chains are irrelevant to them,” he said.

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Cutting PEPFAR — whether in part or entirely, as remains to be seen — not only endangers lives and livelihoods, said Adam Phillips (no relation to Brent), CEO of Interfaith America, but it seems to be the death of values that transcend bitter partisanship. PEPFAR was started by President George W. Bush’s administration and has been a great success under multiple presidents.

“You had folks who disagreed on seven things per day who agreed on PEPFAR,” he said.

To Phillips, if even that most fundamental good is no longer secure, the future of functional governance and civil discourse looks bleaker than ever.

For decades, PEPFAR has even survived attempts from anti-abortion advocates to restrict funds, or hold the entire program hostage to anti-abortion stipulations like the Mexico City Policy, which prevents government funds from going to any organization that performs or promotes abortion as family planning. While these regulations changed with Republican and Democratic administrations, PEPFAR itself was preserved.

Regardless of who was in the White House and how they regulated the program, Matthew Loftus, a missionary doctor in Kenya, never felt a tension between his personal opposition to abortion and his support for PEPFAR.

In the early years of PEPFAR, while the Hoyts were adopting their baby girl in Uganda, Loftus was a college student traveling to neighboring Kenya on mission trips. He quickly learned that the argument for PEPFAR wasn’t only “pro-life” in the broad sense that many aid groups mean when they say a program promotes and sustains life. There was actually an argument to be made for PEPFAR as a program that reduced the number of abortions.

“Every pregnant mother who has HIV is in a crisis pregnancy,” Loftus said. Faced with passing the virus on to her child, many mothers feel compelled to have abortions. Treatment available through PEPFAR can reduce that risk to less than 1%.

Loftus saw firsthand how the funding freezes created chaos in a system so dependent on consistency. He was visiting family in the U.S. in March, but he knew that by the time he returned, the closures of local clinics and layoffs of staff would start to show themselves.

“Our hospital is going to start seeing people who were covered under PEPFAR,” he said.

He was prepared to see cases that would have been manageable become unmanageable. Tuberculosis, pneumonia, and all of the other infections that come with untreated HIV were going to complicate treatment even for those who have enough funding to stay open.

“It makes me sad and angry that people decided to run roughshod over a program that was so effective and carefully designed,” Loftus said.

While damage is done, he said, and the worst could still be yet to come, there’s still some hope that more of the program can be restored. He hopes the churches that send missionaries like him to work in places where the AIDS crisis is ongoing will be among those fighting to save PEPFAR — the aid that raises the dead.