The Policies Of The Trump Administration May Kill More People In Africa Than In Iran

The Policies Of The Trump Administration May Kill More People In Africa Than In Iran

By

Leonard Zwelling

https://www.nytimes.com/2026/04/25/health/pepfar-hiv-aids-zambia.html?searchResultPosition=1

I need to put this into context for those readers born after 1980.

In the early 1980s, I was doing my early research into the molecular actions of cancer chemotherapeutic agents as a trainee and then Senior Investigator in Building 37 at the National Cancer Institute in Bethesda, MD.

A few floors above the lab in which I worked, was Bob Gallo’s empire. His focus at the time was defining the cause of a new disease, AIDS. As history shows, he was excluded from receiving the Nobel Prize for the eventual discovery of HIV presumably because there were questions about exactly what his contributions to the discovery really were and whether they were his. I am not an expert on all the ins and outs of the reasons for his omission from the prize. I do know that he was a very unpleasant man who chewed up many young trainees and investigators who chose to work with him.

Also on the NIH campus was a clinical investigator focusing on the same problem in patients, mostly young, gay men. The disease’s epidemiology suggested that it was of infectious in origin. His name was Tony Fauci. We ran together once.

Twice in 1982, after he had become the Director of the NIH, my former Chief of Medicine at Duke, James Wyngaarden, came to dinner at our house in Potomac. Genie had always said that she listed the crystal, China, and silver in our wedding register “for the time Dr. Wyngaarden would come to dinner.” Then, he actually did.

We invited a few other prominent people we knew. Josh Fidler, Margaret Kripke, Allen Lichter, and my boss Kurt Kohn. The main topic of conversation then at the dinner, at the NIH, and in the world was the efforts to understand the epidemiology and etiology of this new lethal disease, AIDS.

Also, at this time my late father-in-law, Jerome I. Kleinerman, was the Chief of Pathology at Mt. Sinai in New York. He was telling us about the new disease he was seeing at autopsy in young, gay men characterized by the collapse of their entire immune system. These early AIDS patients died of overwhelming infections. Some had unusual malignancies like Kaposi’s sarcoma. Like everyone else, my father-in-law knew this was something different, but not what it was.

I was there at the dawn of the science, politics, and controversy when AIDS killed thousands.

Every once in a while, when we old docs get together, we discuss our past experiences, good and bad. As an oncologist, I have seen some pretty awful human misery. I think the two worst diseases I have ever seen were Stage 4 ovarian cancer and end-stage AIDS.

Today, with excellent screening and miraculous drugs, end-stage AIDS is not seen very often in the United States. It is, however, regularly seen in Africa. One of the best things President George W. Bush did during his eight years in office was initiate the President’s Emergency Plan for AIDS Relief, PEPFAR. This program has probably saved millions of lives in Africa through the use of effective anti-HIV drugs and the opening of thousands of clinics so that all those infected or potentially about to be could receive the best care science and medicine could offer, whether in Bethesda or in Africa. The life expectancy in Zambia had dropped to 37. After PEPFAR it rose back to 67. PEPFAR is probably the best thing that George W. Bush ever did.

In the attached article from The New York Times on April 27, Stephanie Nolen describes the consequences of the Trump Administration’s aggressive cutbacks to PEPFAR. HIV caseloads are rising dramatically. The Trump Administration wants any further aid to be met with access to African minerals. Like every interaction connected to Donald Trump, there has to be a transaction in there someplace. It’s always about what’s in it for me.

Here are some of the consequences of the current Trump policy towards aid to Africa in the fight against HIV listed in the article:

1. Index testing of potential contacts once an HIV-positive individual has been identified is gone.
2. Regular testing of HIV-positive pregnant women is gone.
3. Testing of babies of HIV-positive mothers is delayed until a cheap test can be used 6 weeks later. The early test for HIV in infants is too expensive.
4. Routine testing of all patients for HIV is gone.
5. Identification of “hot zones” of infection with subsequent large-scale testing in the hot zone is gone.
6. Many local sites of distribution of anti-HIV drugs have been closed.
7. Workers making sure HIV-positive patients take their drugs have been fired.
8. Electronic tracking of cases is gone.
9. Training of teenage girls in how to avoid infection is gone.

And this is only some of the actions of the Trump Administration that will lead to far more death in Africa than could be imagined in Iran.

The Trump Administration does not understand the success America has had through the use of soft diplomacy in places like Africa. If rather than decrease the funds to fight HIV in Africa, the Trump Administration had just kept up the current program, negotiating mineral rights would have been easy. The Trump policies will drive these African nations into the arms of the Chinese.

Once again, I am going to go on record as saying that the Trump Administration makes foolish and ignorant decisions because it is led by foolish and ignorant people.

It is very sad that the America First part of the MAGA doctrine needs to lead to so much death, but, alas, it does.

We used to be so much better than this.