The culture wars turn deadly

Today, Explained

This episode of Today, Explained examines how U.S. foreign aid cuts under Trump’s second term—driven by ideological shifts and figures like Elon Musk—are undermining global HIV prevention and treatment programs, particul

Key takeaways

• PEPFAR saved an estimated 25 million lives since 2003 but now faces unprecedented cuts under Trump’s second term

Transcript preview

Speaker 1 (0:00) What's Elon been up to lately? He says he's going to make a historically accurate version of The Odyssey by end of year. That's a work of historical fiction, by the way. He's suing Minnesota over a new law that protects people from having naked images of themselves generated by AI, a thing his ex-AI loves to do. And he's getting in fights with the economist over who's hated more, Musk or the media. Maybe some people do love with me. I don't care. A quarter billion people follow me. I think a lot more people actually like me than don't. and I think a lot more people hate you and the media more than you realize. He's got time to do all that because he's no longer slashing and burning the federal government. On today, Explain from Box, we're going to take a look at one set of doge cuts, those to HIV treatment and prevention. Around the world, something like 1,700 clinics have shut down. 16,000 health workers have been laid off. People are dying, but somehow there's reason to be hopeful. Can Europe defend itself without America? And what is Ukraine's path to victory? I'm John Feiner. And I'm Jake Sullivan. And we're the hosts of The Long Game, a weekly national security podcast. This week, Polish Deputy Prime Minister Roddick Sikorski joins the show to break down the shifting transatlantic alliance and what comes next in Ukraine. China, unlike us, actually could force Russia to end the war. But my guess is that the war suits China just fine. The episode's out now. Search for and follow The Longer. game wherever you get your podcasts. Support for the show comes from Chime. Chimms changing the way people bank by offering rewarding fee-free banking. You can join the millions, millions who are already banking fee-free with America's number one choice for banking. You can add to chime.com slash explain. That's chime.com slash explained. You can sign up now. It only takes a few minutes. Chime is a fintech, not a bank. Banking services and chime card provided by Chimes of bank partners, qualifying direct deposits required. Terms and limits apply. Go to chime.com slash disclosures for details. This is today explained. Sarah Hirshander is a reporter at Vox, and her most recent reporting is on how we're intentionally losing a fight we could win. I think we should start in 2003. And the reason why I think we should start there is that that's when the U.S. got involved in this so-called fight against HIV. 2003 was when HIV was surging across sub-Saharan Africa. if you look at a chart of like infections and deaths from AIDS at the time, it is like at the top right in this moment. Millions of people were dying each year. Southern Africa now has the fastest rate of AIDS growth in the world. Today on the continent of Africa, nearly 30 million people have the AIDS virus, including three million children. It was also just a few months before the U.S. invaded Iraq. We had George W. Bush, famously a republic, in office. He's giving a state of the union in January, and to the surprise of pretty much everyone, he decides to allot $15 billion of U.S. funding to this global fight against HIV. Ladies and gentlemen, seldom has history offered a greater opportunity to do so much for so many. He was working with a bunch of medical experts behind the scenes, including Anthony Fauci, someone people might recognize. And that was when the U.S. really liked. put its foot in the door, and it ended up being a huge success. If you think about that chart I mentioned earlier, we're at the top of infections right now. It goes down after 2003. And PEPFAR, which is what the program ended up being called, the president's emergency plan for AIDS relief, which describes any U.S. funding directed toward this global fight against HIV, just expanded, became better as time went on. Sure, there were problems over time, but every presidential administration after Bush, after 2003, continue to provide funding through this program. And people often remember that George W. Bush may be responsible for the deaths of hundreds of thousands of people in his Iraq war. But how many people may he have saved through PEPFAR? Yeah, this is the crazy thing. Like, it might have been the best thing that a U.S. president has ever done. Say it again. Say it again. Don't make me say it again, Sean. The one of the, or perhaps the most consequential things, arguably the best thing that a U.S. President has ever done. I like to say it was a rare W for George W. Bush—saving 25 million lives. 25 million. That's how many people have been, whose lives have been saved because of PEPFAR services. And you can't even count the number of people, many more millions of people who probably didn't even get HIV in the first place. because of these all-important prevention services. Those are like World War numbers, Sarah. It's crazy. It's so crazy. Okay, an incredible win that maybe George W. Bush doesn't even get enough credit for. But in his defense, they don't kill the program in Obama 1, Obama 2, Trump won, Biden won. but then what happens in Trump's second term when Elon shows up with the chainsaw? Yeah, so PEPFAR, at least at the very beginning, was not immune from Doge and from these broader major cuts to U.S. foreign aid that was led by Elon Musk. When he first came in, Musk decided to freeze pretty much all U.S. foreign aid, and PEPFAR was included in that freeze. People were so worried about it and they were so much uproar because, again, this was always a bipartisan program. The outroar was big enough that they decided not to kill PEPFAR entirely. But what we're seeing now over a year later is that while PEPFAR still technically exists, it's been entirely reshaped under the Trump administration. And that refers to both funding. There's just less