In April, I stood on the soft green lawn of the home of a retired police captain in Uganda, surrounded by older women with H.I.V. The crowd, which included many grandmothers, wore formal outfits, fit for church, a show of respect and appreciation for the team arriving from a clinic 30 minutes away to deliver the antiretroviral drugs that kept them alive. They watched in grave silence as a nurse, pharmacists and counselors from the AIDS Support Organization (TASO) in Tororo, Uganda, unpacked their drugs, pharmacy log books and other supplies.
When a counselor jokingly chided them, “Why aren’t you happy to see us?” the crowd offered a perfunctory cheer. Then clients said that they’d heard news of the Trump administration’s changes to foreign aid. Many of them wept as they explained their fear that TASO Tororo wouldn’t come as scheduled. A grandmother of 12, fearing for the survival of her teenage granddaughter, also living with H.I.V., pleaded to me, an American, to convince whoever in my government had put the program in jeopardy to relent. “Change the heart,” she begged repeatedly, then collapsed forward, her body shaking.
It was 20 years ago that I made my first visit to Tororo,. A rural community where roughly a third of residents live on less than a dollar a day, Tororo is a world away from Washington. But the U.S. Senate could influence the fate of H.I.V.-positive people there this week. Lawmakers have until July 18 to vote on a bill, known as a “rescission package,” that would slash $900 million for global health, including $400 million for the President’s Emergency Plan for AIDS Relief, or PEPFAR, which supports H.I.V. treatment worldwide. It has saved 25 million lives since it was established by President George W. Bush 22 years ago.
The package retroactively approves the unlawful actions of the Department of Government Efficiency, which in January and February halted foreign aid and other spending already approved by Congress. While Secretary of State Marco Rubio approved a waiver to continue PEPFAR’s lifesaving services, including the distribution of antiretrovirals, the maelstrom of grant cancellations and terminations at the U.S. Agency for International Development left the H.I.V. program in chaos.
This was evident in Tororo. When the medical team arrived with drugs for the grandmothers and other clients in April, they hadn’t received salaries for three months as a result of a canceled grant. Nor had TASO staff members, who support more than 120,000 people across the country. And yet, counselors, doctors, nurses and peer educators kept showing up. Many counselors and educators also have H.I.V., and they told me that abandoning their clients was unthinkable.
Mr. Rubio has positioned himself as a champion of PEPFAR. And indeed, his waiver, PEPFAR’s operational structure (it has been housed in the State Department and implemented by multiple government agencies since it began) and the work of volunteers like those in Tororo have kept the program operational, even as U.S.A.I.D. formally shut down this month.