A major campaign is underway to overturn administration cuts to global HIV/AIDS funding, with claims that such cuts are killing millions of people, causing global turmoil, and advancing China’s global agenda.

That sounds grave. Fortunately, it’s completely untrue. 

On Inauguration Day, the White House ordered a 90-day pause to review all U.S. foreign aid. U.S. Secretary of State Marco Rubio characterized some aid as “counterproductive to American interests, wasting taxpayer money and provoking resentment abroad.”   

Rubio was right. Foreign aid had gone “off the ideological rails” by supporting progressive agendas — something that has earned it the rebuke of Congress. 

The aid pause generated ire in proponents of the $6.5 billion annual President’s Emergency Plan for AIDS Relief or PEPFAR, a U.S. government program launched in 2003 when Africa faced an out-of-control AIDS epidemic. A powerful coalition of NGOs, churches, contractors, foundations, universities, and pharmaceutical companies have coalesced in a lobbying campaign to shame Republican legislators into rejecting any cuts to the program whatsoever. 

Only two months into the aid freeze, U2 rock star Bono claimed that “300,000 people have already died.”  Bill Gates, a major global AIDS benefactor, warned of “millions” dying if cuts are not reversed. UNAIDS predicts 4 million deaths per year by 2030.  

It gets worse. Former USAID administrator Andrew Natsios warned freezing aid “is going to destabilize countries” and force them to go “to China.”  

But all these charges are false claims, designed only to scare lawmakers into restoring their annual funding levels.

It has been six months since the administration’s review began, and there is no news from PEPFAR-funded countries that thousands have been dying from aid cuts.

Nor have aid cuts caused global collapse. South Africa, the top PEPFAR recipient, declared, “it is inconceivable …[that aid cuts] will lead to a collapse of the entire programme.”  

Under Trump, no African country has imploded. In contrast there were coups d’etat during the Biden administration.

Instead, in a welcoming development, Africans are taking ownership to care for their own people and reduce dependency on foreign taxpayers.

Equally absurd is the oft-repeated charge that cuts in global HIV funding will cause them to turn to China. In fact, 19 of the top 20 recipients of U.S. foreign aid were already members of China’s Belt and Road Initiative before any of this. Among them, last year, Mozambique and Tanzania hosted joint military exercises with China’s navy, and South Africa is the S in the BRICS alliance created by China in 2009 to undercut U.S. global leadership.

These are three of the top four PEPFAR recipients. Clearly, these issues are unrelated. 

The real driver of this campaign is the foreign aid industry, which currently stands to lose billions in taxpayer funding. Both the U.S. Senate and the House of Representatives recently ripped the foreign aid industry for its high overhead charges, which sometimes exceed 50 percent of their total grants.

Republican lawmakers considering this manufactured hysteria must be made to understand that 98 percent of political donations from the PEPFAR industry go to Democrats. Know that a big chunk of that $6.5 billion annual congressional gift is being used against your re-election campaign.

The Gates Foundation’s global AIDS work is admirable, but it relies on large U.S. government co-financing. Aid advocate ONE Campaign, founded by Bono a year after PEPFAR’s launch, received $40 million from the Gates Foundation. Forty percent of UNAIDS budget is covered by the U.S. government.

PEPFAR is big business and a career to many. 

PEPFAR has also saved millions of lives. But it is an emergency program— that’s what the “E” in PEPFAR stands for — created in response to a crisis in Africa. Twenty-three years and $125 billion later, some would have it become a global entitlement program in perpetuity.  

Like so many entitlement programs, domestic and foreign, PEPFAR spending spawned an industry heavily vested in its self-perpetuation that is now rife with waste, fraud and abuse.  

Last month, the U.S. Embassy in Zambia announced $50 million in aid cuts after finding that HIV, tuberculosis, and malaria drug donations had been systematically pilfered by government officials for years and resold by corrupt pharmacies. In 2020, USAID found large-scale fraud by Kenya’s state-run medical supplies company involving hundreds of millions of dollars’ worth of antiretroviral drugs. The Global Fund against AIDS, tuberculosis, and malaria is similarly dogged by corruption scandals.  

During these scandals PEPFAR lobby did not issue a single peep about thousands dying as a result. 

And add government incompetence to the mix as well. Recently, a $9.5 billion global health supply chain contract, intended to be the U.S. government’s backbone to support poor countries, collapsed after years of planning. Now, no system exists to maximize delivery efficiencies of billions of dollars’ worth of medicine. 

Last year, the U.S. Center for Disease Control reported that PEPFAR funds illegally funded abortions in Mozambique, confirming African leaders’ accusations of widespread abuse. That prompted PEPFAR supporter Senator Jim Risch to fume, “this violation means the future of the PEPFAR program is certainly in jeopardy.” 

Thankfully, PEPFAR has also created an African cadre of experts that can operate HIV programs themselves—without the bureaucratic bloat of the PEPFAR industry. By working directly with African churches, which are the core of medical care in Africa (as in the U.S.), Congress could cut PEPFAR’s cost by half, improve delivery effectiveness through local partners, and empower Africans to take ownership of a program that should be transitioned to them anyway. 

That is the PEPFAR industry’s worst-case scenario. 

Max Primorac is a Senior Research Fellow in the Margaret Thatcher Center for Freedom at the Heritage Foundation.