Trump's PEPFAR Shutdown is White Supremacy in Action

On Monday morning, a healthcare worker posted a final notice on the door of a small clinic in Johannesburg, South Africa: "Visit the clinic today before 4 PM to collect your medication." By nightfall, the clinic had shuttered its operations, its social media accounts had vanished, and thousands of HIV patients were left wondering where they would get their next dose of life-saving medication. This scene played out across sub-Saharan Africa as the Trump administration's sudden stop-work order brought PEPFAR - the U.S. President's Emergency Plan for AIDS Relief - to a grinding halt, cutting off medical support to 20 million people worldwide, the vast majority of whom are Black and poor.

This is an action rooted in white supremacy and eugenic thinking. With a single directive issued on a Friday afternoon, the administration - if one can call it that - dismantled an entire global health infrastructure that predominantly serves Black and marginalized communities. Clinics closed. Information systems went dark. Healthcare workers were laid off. And most critically, the pipeline of anti-retroviral medications that keep HIV in check for millions began to run dry.

This decision is driven by racism. PEPFAR primarily serves communities in sub-Saharan Africa, where the HIV/AIDS epidemic has hit hardest. By cutting off life-saving medication, Trump and his owner/operators have sent a clear message about whose lives they value. The move fits into the pattern of Trumpist policies that disproportionately harm people of color, from the Muslim ban to family separations at the border to the undermining of voting rights.

When a patient stops taking their HIV medication, the virus multiplies and mutates, becoming resistant to the drugs that kept it at bay. By forcing millions of predominantly Black patients to interrupt their treatment simultaneously, Trump has engineered the perfect conditions for a surge in drug-resistant HIV strains. This isn't negligence. It's a calculated assault on public health that is designed to affect non-white communities.

The timing speaks volumes. These clinics received their stop-work orders with barely 24 hours' notice. There is no transition plan. No emergency protocols. In Tanzania, USAID partners received a brutal memo: "immediately stop, cease, and/or suspend any work being performed." The language leaves no room for ambiguity or compassion - particularly for the Black and brown communities that rely on these services.

What does it mean when a government weaponizes healthcare along racial lines? When it deliberately creates conditions that will lead to mass suffering in predominantly Black communities? We know the answer.

Trump and his cronies and handlers have systematically dismantled public health infrastructure while promoting white nationalist policies and rhetoric. The PEPFAR shutdown is an escalation of this strategy.

220,000 patients visit PEPFAR-supported clinics daily. That's a quarter million people, predominantly African, whose lives hang in the balance of this decision. According to reporting by the New York Times and NPR, Dr. Deborah Birx, former Global AIDS coordinator, estimates that patients who received medication in early December will run out by February. After that, the dominos begin to fall. Without medication, HIV-positive patients become ill. The virus spreads. Communities struggling with limited healthcare resources face a new wave of preventable suffering.

This shutdown breaks with decades of bipartisan consensus on global health. PEPFAR, launched under President George W. Bush, was concrete proof of American leadership in fighting HIV/AIDS globally. It bypassed political divisions, uniting conservatives and liberals behind a common humanitarian cause. Now, that legacy lies in ruins.

The administration's defenders might argue this is about fiscal responsibility or reviewing foreign aid. These are the same individuals who claim that a Nazi salute is a gesture of love. And they are, to be blunt, not fooling anyone.

PEPFAR's $6.5 billion annual budget represents a fraction of U.S. foreign spending. And the cost of allowing HIV to resurge globally - in both human and economic terms - far outweighs any short-term savings.

Senior PEPFAR officials have submitted waivers to the State Department to resume medication distribution. These waivers sit unsigned while the clock ticks on patients' medication supplies. Every day of delay moves us closer to the point of no return - a calculated indifference that echoes historical patterns of medical racism.

PEPFAR's data systems, which tracked everything from local program effectiveness to country-level commitments, have been shut down. Half USAID's global health bureau workforce - contractors critical to program implementation - have been laid off.

In the face of this manufactured crisis, healthcare workers and activists scramble to mitigate the damage. Organizations like Health GAP fight to maintain some semblance of care continuity. But without the backing of the world's largest HIV/AIDS prevention program, their efforts face overwhelming odds in communities already bearing the brunt of global health inequities.

The road back from this precipice grows steeper with each passing day. Even if funding resumes tomorrow, the damage to healthcare infrastructure and patient trust will take years to repair. Drug resistance patterns, once established, cannot be easily undone. Communities destabilized by preventable health crises face a long road to recovery.

As medications run out and clinics remain closed, history will measure the cost of this decision in lives lost, communities devastated, and a global health crisis needlessly amplified.

This moment demands recognition of what it represents - a policy decision that follows in the dark tradition of American eugenics and medical racism. When a government deliberately creates conditions that will lead to mass suffering in predominantly Black communities, when it dismantles life-saving healthcare infrastructure without warning or contingency, it reveals its true values.

And those values can only be summed up as white supremacy.