It is terrible to watch people die of AIDS. Once H.I.V. destroys a person’s immune system, he or she becomes susceptible to diseases that the rest of us never have to worry about. The suffering is immense, and the worst part for medical professionals is the sense of helplessness we feel when a patient reaches the point of no return. While H.I.V. medications can do wonders for people who are very sick, once an infection like tuberculosis of the brain takes over, there is almost nothing that we can do.
As a medical missionary working in East Africa for the past decade, I have seen this happen to my patients. Compounding the tragedy is the fact that it is usually young people, sometimes young mothers and fathers, who are cut down in the prime of life by AIDS. I hope that you never have to witness it yourself.
More often, though, I see H.I.V.-positive patients who have been taking antiretroviral medications paid for by the President’s Emergency Plan For AIDS Relief. For two decades, Pepfar has provided the medications that keep people from getting infected in the first place. I have seen people who were very sick—just shy of “too late”—get better in the hospital and come back to the clinic healthy and functional. I have seen a lot of people who probably would have died years ago, had the H.I.V. virus not been suppressed by antiretrovirals that Pepfar paid for.
I have talked to doctors who were in Africa at the height of the epidemic in the 1990s and early 2000s. They describe scenes of absolute carnage, people dying all the time. Wards full of children dying before they reached their second birthday. Pepfar undid that. For the past 20 years, Pepfar has turned H.I.V. from a death sentence into a chronic but manageable condition. Thanks to Pepfar, I am more likely to see someone who is H.I.V.-positive for a heart, lung or kidney problem than I am to see patients for an infection because they are no longer immunosuppressed.
In January, all of that collapsed when President Donald J. Trump signed an executive order freezing all foreign aid. There were waivers for lifesaving work issued immediately thereafter, but due to the chaos at the U.S. Agency for International Development and the State Department, most clinics and hospitals reported that they weren’t able to get funds. Some hospitals diverted resources from other departments while furloughing some of their staff to ensure that people got their medications. There has been a lot of chaos and uncertainty.
Medical workers are still doing the best they can with what they have. Other clinics are still closed and had to tell much of their staff that their jobs are gone. Many people are afraid of what the future holds because upcoming budget negotiations could destroy everything for which Americans and Africans have worked together since 2003.
I am grateful that there are still a lot of people who believe in Pepfar’s mission and the power of foreign aid from America to do good in the world. While there was undoubtedly corruption, fraud and waste in that arena, choosing to renege on contracts and shut down programs without any warning or preparation was foolish and destructive. The mandate to make sure that taxpayer dollars are well spent is an important one, but Pepfar was one of the most robust, efficient and well-supervised programs in foreign aid. There was no need to shut it down suddenly. Now it is imperative that we get as many of the good things back up again as quickly as possible.
One of the things that U.S.A.I.D. and Pepfar were working on were clinical trials to find even more effective ways of preventing and treating H.I.V. It is possible that we will see H.I.V. go the way of smallpox and polio in our lifetimes, but this won’t happen if the United States decides to stop funding Pepfar.
I wish I could bring all of you to my hospital to meet the people who have benefited from Pepfar. I wish I could bring the people who have the power to restore Pepfar over here, too, and let them see the good that the U.S. government has done. I wish they could see what happens when someone dies of AIDS; I think they would be a lot more eager to restore Pepfar if they could.
Every year, I fast from something during Lent to join with my ancestors in the faith as well as my brothers and sisters in Christ. This year, I am abstaining from all food between 7 a.m. and 7 p.m. every day to focus my prayers on Pepfar and people living with H.I.V. around the world. Many H.I.V. medications are taken twice a day, so fasting for 12 hours a day seems like the most reasonable way to help me direct my prayers. I know that many people supported by Pepfar will likely forgo food in order to buy the medication they need, so this helps me to remember to pray for them.
I am well aware of the dangers of “raising awareness” and making a show of one’s fasting (Mt 6:16-18). But I am telling people about this publicly so that they can consider whether Pepfar is something they would like to fast over during Lent. I am fasting to remind myself and others that nothing I do, and nothing the president, vice president, secretary of state or anyone else can do, will stop God from caring for his people.
My personal vocation has led me to teach and minister to medical professionals in a mission hospital, but anyone can pray for God to do great things. My appeal is for Christians to direct their prayers during this Lenten season toward Pepfar and people living with H.I.V., with the expectation that God will deliver them and that he will be glorified as they live long and healthy lives.
America is great because America does good things. We are too close now to give up. I do not want us to go back to the carnage we saw before Pepfar. I want to be able to tell my friends, my colleagues and my patients that Americans are willing to invest in their lives because America does great things.
