After months of uncertainty surrounding PEPFAR, America's premier AIDS relief program, including the 90-day foreign aid freeze that shuttered health centers and halted medication distribution worldwide, the Trump administration last month released its FY 2026 budget request. While the request includes renewed funding for the program, it slashes the budget by $1.9 billion, a 39% reduction. This hollowed-out version of PEPFAR leaves millions of people currently dependent on life-saving treatment facing an uncertain future. It also undermines a cornerstone of U.S. foreign policy—one that extends well beyond global health to advance American interests.

What is PEPFAR?
Launched by the Bush administration in 2003 to combat the global HIV/AIDS epidemic, PEPFAR is the largest commitment by any nation to address a single disease internationally and has been a pillar of global health since its inception. Today, the U.S. Department of State’s Bureau of Global Health Security and Diplomacy primarily oversees PEPFAR’s operations, and works closely with the private sector and civil society in partner countries to achieve HIV/AIDS epidemic control while promoting frameworks for long-term disease prevention.
 
PEPFAR stands out as one of the most effective and cost efficient U.S. foreign aid programs, delivering remarkable results while accounting for just 0.08% of federal spending in 2024. Over the course of its history, the program has placed 20.6 million people on life-saving antiretroviral treatment, reached 2.3 million adolescent girls and young women with comprehensive HIV prevention services, provided 83.8 million people with HIV testing services, and allowed 7.8 million babies to be born HIV-free.

While these statistics are compelling, it is fair to question how a program operating largely beyond U.S. borders serves the interests of the American people. The answer lies in recognizing that the data reflects only a fraction of PEPFAR’s broader significance. More than a global health initiative, PEPFAR functions as a multifaceted diplomatic tool that bolsters U.S. national security and reinforces American global leadership.

_Strengthening National Security _
PEPFAR is a key contributor to the Department of Defense’s global health efforts through its support of the HIV/AIDS Prevention Program (DHAPP) at the Defense Health Agency (DHA). By partnering with foreign militaries, DHAPP implements cooperative strategies that combine HIV/AIDS cooperation with security assistance to reduce the disease’s impact on global militaries and other uniformed organizations. This ensures that military communities remain capable of responding to threats and engaging in peacekeeping operations. For U.S. troops, PEPFAR investments strengthen military readiness and reduce the risk of disease outbreaks, enabling safer, healthier deployments with DHA support.

Combatant command missions abroad depend on PEPFAR and DHAPP as tools to reduce instability and extremism, key objectives of the National Defense Strategy’s posture of integrated deterrence. Data from the World Bank shows that, since 2004, PEPFAR-supported countries have experienced up to a 40% reduction in political instability, compared to just 3% in non-PEPFAR countries since 2004. If PEPFAR were terminated, HIV/AIDS-related deaths could rise by as many as 4.2 million between 2025 and 2029. Such a death toll would contribute to greater regional instability, heightened extremism, and a more dangerous operating environment for both U.S. and partner forces.

Strategic Counter to the PRC
The relationship between the United States and China is a defining force in today’s geopolitical landscape. As the U.S. works to maintain global influence, PEPFAR remains a key diplomatic asset, particularly across the African continent. While African leaders and citizens still overwhelmingly prefer engagement with the U.S. over China, recent gaps in American engagement have led some nations to reassess their international alignments. This is especially pertinent given China’s 2024 announcement of $51 billion in new foreign aid to Africa targeting infrastructure projects and massive job creation. In this regard, the benefits of PEPFAR extend beyond public health to measurably strengthen America's diplomatic position in this competitive landscape. Countries receiving PEPFAR aid report a 6.3% increase in favorability toward the U.S., demonstrating how PEPFAR is a strategic necessity for maintaining American leadership in regions where the future of global power will be determined.

_Pandemic Prevention _
For the American people, PEPFAR’s most apparent value lies in its contribution to global pandemic prevention. During the COVID-19 pandemic, PEPFAR’s investments were adapted to strengthen existing disease surveillance infrastructure and laboratory diagnostics, while also training health workers to deliver COVID-19 care and administer vaccines once they became available. Globally, PEPFAR has strengthened health systems by investing in thousands of laboratories for HIV/AIDS, tuberculosis, and cancer and training healthcare professionals. This kind of proactive work allows PEPFAR to be used as a tool to counter emerging health threats, which helps prevent diseases from reaching American borders. Cutting PEPFAR would undo decades of progress in the global fight against HIV/AIDS and weaken a critical line of defense against future pandemics, ultimately leaving Americans more vulnerable to global health threats.

The Future of PEPFAR
The absence of an official explanation for the 39% cut to PEPFAR funding, or any details on which aspects of the program were deemed ineffective or wasteful, reflects a troubling lack of transparency. It also leaves program administrators in a difficult position, forced to make painful decisions about which life-saving services to reduce or eliminate, without clear guidance on priorities or strategy. If not handled well, this will lead to a PEPFAR that is in disarray, trying to cover too much with far too little.

The question facing policymakers is not whether America can afford to fund a fully operational PEPFAR, but whether America can afford to weaken a program that has proven itself indispensable to our national security, global competitiveness, and public health preparedness. In an era of great power competition and emerging global threats, reducing PEPFAR is a strategic blunder that weakens America's position precisely when strength matters most.