President Trump was moved to launch an attack on an air base in Syria in part because of images he saw of the youngest victims of Syrian dictator Bashar al-Assad’s most recent chemical assault on civilians. “Even beautiful babies were cruelly murdered in this very barbaric attack. No child of God should ever suffer such horror,” Trump said while explaining the strike, as if he were learning of such atrocities being committed at the hands of the Assad regime for the first time. While I commend his rare public display of empathy, I hope he will give the same direct and forceful action to avert the deaths of hundreds of thousands of children a year from HIV/AIDS.
As the national debate unfolds regarding the merits of this air strike, George W. Bush, the last Republican president to drag us into war in the Middle East, is devoting his time to asking Congress to continue supporting the President’s Emergency Plan for AIDS Relief (PEPFAR), arguably his greatest public health legacy. This flagship program has pioneered HIV prevention efforts and provided essential medications and health care to people living with HIV in 65 countries around the globe. “Saving nearly 12 million lives is proof that PEPFAR works, and I urge our government to fully fund it,” Bush wrote recently in a Washington Post op-ed in response to the nearly $300 million cut to the program in the Trump administration’s latest budget proposal.
By paying to test pregnant women for HIV and getting them onto lifesaving drugs that also prevent the transmission of HIV from mother to child — in utero, during birth, and later via breastfeeding — PEPFAR averts thousands of infant infections each year and more than 1.5 million since 1995. Given the high mortality rates of infants with HIV, that translates into thousands upon thousands of children who owe their lives and futures to the program. If Congress makes cuts to PEPFAR, more of these avoidable deaths will occur — deaths that will be no less horrific than those that compelled Trump to act in Syria. And we will be just as culpable.
I can see PEPFAR in action today from my vantage point working in a hospital in Rwanda, a country that is currently observing the 23rd memorial of the Tutsi genocide in the spring of 1994 that killed more than 800,000 civilians while the world looked away. Last year, in tiny Rwanda alone, PEPFAR tested 1.6 million people for HIV, provided treatment for nearly 100,000 people living with HIV, and worked with more than 4,000 pregnant women with HIV so they wouldn’t transmit the virus to their children — all that for less than three-quarters the cost of the 59 Tomahawk missiles launched at the Syrian air field. PEPFAR was also there to provide education, protection, and psychosocial and economic support for more than 70,000 orphans and children affected by the epidemic in the country. It is hard to overstate the impact of this program on lives in Rwanda and around the world.
In the words of Paul Rusesabagina, the protagonist of the movie “Hotel Rwanda,” “We make decisions based on emotion and then justify them later with whatever facts we can scrounge up in our defense.” While that may be true, it is not how a superpower like the US should make difficult decisions regarding funding priorities or the use of its formidable military arsenal.
Cutting funding from indispensable programs like PEPFAR, which are already working effectively to save innocent lives worldwide, while lobbying to divert public funds into the machinery of war to be wielded abroad in the name of preventing bloodshed, represents the height of hypocrisy. If Trump truly wants to save the world’s beautiful babies, he should expand, not decrease, funding for PEPFAR and other effective global health programs.
Nicholas Cuneo, MD, is a resident physician in internal medicine and pediatrics at Brigham and Women’s Hospital, Boston Children’s Hospital, and Boston Medical Center. He is pursuing work in global health and refugee health through the Harvard-affiliated Doris and Howard Hiatt Residency Program in Global Health Equity.