Why Evangelicals Turned Their Back on PEPFAR

I

n 2006, Ambassador Mark Dybul, then the United States global AIDS coordinator, visited an orphanage run by the Daughters of Charity in Ethiopia. It was a sanctuary for more than 400 HIV-positive babies and young children found in garbage heaps, abandoned on the roadside, or left at the orphanage door. As Dybul and Michael Gerson, then a senior policy adviser to President George W. Bush, walked through the massive campus, they came to the dining hall, where they saw a mural of Jesus surrounded by a group of children. The sisters told them that the mural featured portraits of children who had died of HIV at the orphanage, and that the children came there to talk to and play with their friends on the wall.

The epidemic was hardly confined to Ethiopia. It was ravaging sub-Saharan Africa. Two-thirds of the 40 million people in the world infected with HIV lived in that region. More than 12 million children had been orphaned by AIDS.

“We really are in a national crisis,” the president of Botswana, Festus Mogae, said in 2000. “We are threatened with extinction. People are dying in chillingly high numbers. We are losing the best of young people. It is a crisis of the first magnitude.”

In parts of Botswana, 75 percent of pregnant women had HIV. Most diseases kill the very old and the very young, “but this disease was killing the most productive and reproductive parts of society,” Dybul recalled in 2018. “So not only were many households run by orphans, but entire villages were run by orphans, because everyone else was dead.”

Then came PEPFAR.

The President’s Emergency Plan for AIDS Relief, first authorized by Bush in 2003, was the largest commitment made by any nation to address a single disease. It was, the president said, “a work of mercy beyond all current international efforts to help the people of Africa.” PEPFAR, which received strong bipartisan support, is credited with saving 26 million lives and enabling almost 8 million babies to be born without HIV. It transformed the landscape of the HIV epidemic and helped stabilize the African continent. Not only is PEPFAR the single most successful policy to date in U.S.-Africa relations; it is “ also one of the most successful foreign policy programs in U.S. history,” as Belinda Archibong, a fellow at the Brookings Institution, wrote last year.

During his 2006 trip to Ethiopia, Dybul visited a rural village near Axum. “At dawn, with the mist over the town, it looked as it might have centuries ago,” Dybul told me. “Local farmers winding through the streets with donkey-drawn wagons, the spires of the churches peeking through the haze, bells ringing to call all to prayers and the market. At a visit to the local clinic, the director—who was also a town elder and leader in the community—kept referring to PEPFAR. I asked him what PEPFAR means. His answer knocked me over. ‘PEPFAR means the American people care about us.’”

John Robert Engole arrived at a clinic run by Reach Out Mbuya, a faith-based NGO, in the suburbs of Kampala, Uganda, in 2004. He was very weak, having contracted severe tuberculosis, and his immune system was collapsing. He was suffering from late-stage HIV. But as Esther Nakkazi wrote in Harvard Public Health, Engole became the first person treated as a result of PEPFAR. “The dying stopped after PEPFAR,” Margrethe Juncker, a Danish doctor who cared for urban slum dwellers living with HIV/AIDS in Uganda and who treated Engole, told Nakkazi. She called the program a “miracle.”

Then came Donald Trump.

On the first day of his second term, Trump issued Executive Order 14169, calling for a 90-day pause on all foreign-development and assistance programs pending further review. A subsequent stop-work order froze payments and work already under way, hobbling programs worldwide. The administration dissolved USAID, the main U.S. organization that provides humanitarian aid and the primary implementing agency for PEPFAR.

The stop-work order initially froze all PEPFAR programming and services, halting work in the field, including the provision of antiretroviral therapy. And although PEPFAR—which accounts for 0.08 percent of the federal budget and has been consistently judged to be a highly effective and accountable program—received a limited waiver in February allowing it to continue “life-saving HIV services,” the actual implementation of that waiver has been delayed, fragmented, and chaotic. Supply chains have been disrupted; so have diagnostic and treatment services. There have been mass layoffs of staff. Clinics have been shut down. “The result was unprecedented operational chaos, funding lapses, the collapse of implementation partnerships, and, in many cases, clinic closures,” according to the Center for Strategic and International Studies. Those on the ground report widespread disruption of HIV services and devastating consequences for PEPFAR beneficiaries; the infrastructure that took years to build has been decimated. That will remain true even if the Trump administration were to reactivate PEPFAR tomorrow.

More than 75,000 adults and children are now estimated to have died because of the effective shutdown of PEPFAR that began less than six months ago. Another adult life is being lost every three minutes; a child dies every 31 minutes. Ending PEPFAR could result in as many as 11 million additional new HIV infections and nearly 3 million additional AIDS-related deaths by the end of the decade.

O

nce PEPFAR was announced, a number of evangelical groups and individuals played an important role in supporting it. They understood their faith to call them to care for the sick and the poor, to advocate for the oppressed, and to demonstrate their commitment to the sanctity of life. But as this human catastrophe unfolds, few American evangelical pastors, churches, denominations, or para-church organizations have spoken out against the destruction of PEPFAR. Nor, from what I can tell, do they seem inclined to do so.

Why have so many evangelicals remained silent? Is it mostly explained by ignorance or indifference? Compassion fatigue? Or perhaps fealty to Trump? Is the silence among ministers explained by fear of upsetting congregants? A desire to keep their ministry separate from politics? Other ministry commitments? I put these questions to more than two dozen individuals, mostly pastors, past and present, some of whom were willing to speak on the record and others who requested anonymity in order to speak candidly. The story they tell is a complicated one.

[Peter Wehner: The evangelical church is breaking apart]

Several said that most Christians, and most pastors, simply aren’t aware of PEPFAR. “It’s done extraordinary good, and yet it’s virtually invisible to most,” James Forsyth, of Cedar Springs Presbyterian Church in Knoxville, Tennessee, told me. “That’s a huge part of the problem. Think about walking along the pew in the average congregation, or down the street in the average town: My bet is that the vast majority of people couldn’t tell you what PEPFAR is, what it’s achieved, that it’s under threat, or why that matters.”

Chris Davis, of Groveton Baptist Church in Alexandria, Virginia, and a strong supporter of PEPFAR, told me that for many, the issue seems distant. “Very few evangelicals have walked down Coffin Row in Malawi or know anyone who has,” he said. (Prior to PEPFAR, so many carpenters switched to making coffins in Lilongwe, the capital of Malawi, that their workshops along Kenyatta Drive acquired a new, macabre name.) “So it can be much more theoretical than personal when this is not addressing an issue that your friend, neighbor, or even extended family member is facing, like, cancer or type 2 diabetes.”

A lot of churches really are caring for “the least of these,” to use a phrase from Jesus, and braiding their faith with a social conscience. But they do so on issues other than PEPFAR.

Scott Dudley, of Bellevue Presbyterian Church in Bellevue, Washington, believes the destruction of PEPFAR is a tragedy, but his church is preoccupied with other unfolding changes. “The main reason we haven’t addressed PEPFAR,” he told me, “is because we are more involved with issues around refugees, asylum seekers, and immigration. Our partners in this are Christian nonprofits who lost huge amounts of money in the cuts to USAID.” Congregants, he said, risk being overwhelmed and exhausted, and so he encourages them to focus on the arenas in which they are already most involved. Another person who was involved in church ministry put it to me this way: “We are finite creatures, each called to particular causes. The Church should respond to injustice, but it can’t respond to every injustice all the time.”

Some ministers, instead, cited an aversion to becoming involved in politics, especially politics that might roil a congregation. Many Christians believe that church is meant for worship, not for guidance on policy, even on pressing humanitarian issues. One person told me that the pastor’s responsibility is “to preach the word in season and out and pray that his people grow in Christ enough to change the world in their spheres of influence. On extremely rare occasions—i.e., declaring war on another country—it might be right to preach from the pulpit about an overtly political cause. But in general I think it will only polarize and fragment the church further.”

A principled aversion to politicizing the pulpit was sometimes difficult to distinguish from a very human fear of speaking out on issues that might trigger an angry response from Trump supporters in the pews. Even pastors whose moral conscience might make them inclined to speak out against the decimation of PEPFAR think twice about doing so, because they don’t want to become the target of attacks by members of their own congregation. One conservative-leaning pastor confided to me, “Sometimes I wish I weren’t a pastor so I could speak up more loudly and more clearly.”

A pastor in the Presbyterian Church in America—a conservative denomination—put it to me this way: “There are pastors who act like gatekeepers and spend an inordinate amount of time publicly shaming those whom they politically disagree with on social media, putting pressure on them to respond or even call for resignations.” He worried that the attacks would distract him from his responsibilities to his local congregation. “I wonder what public statements would even accomplish in such a polarized environment, other than to bring grief on my family and church,” he said.

He’s hardly alone. “Any pastor who has ever ventured to speak out on a controversial ‘political’ issue, whether it’s a moral issue or not, knows that he will get tremendous, angry feedback from some of his people,” a man who had pastored an influential evangelical church in Northern Virginia told me. “This causes him to hesitate. He wonders if addressing this issue to his little flock will really be helpful to anyone.” (This individual told me that if he were still pastoring his church, he hopes he would speak out, even if he would do so reluctantly, because “a pastor must also warn his sheep of the dangers around them.”)

Some people in the Christian relief and development community are remaining silent because the administration has proved both capricious and volatile. They still hope to change its course, but fear that public criticism could lead it to dig in. Others pointed to the deep distrust of government that runs through many conservative churches. Since the evangelical move into right-wing politics in the late 1970s, one pastor told me, evangelicals have held as axiomatic the words of Ronald Reagan in his 1981 inaugural address: “Government is not the solution to our problem; government is the problem.” His church supports medical missionaries and nonprofits that work on health issues overseas, but that doesn’t necessarily translate to support for PEPFAR. “There is a general suspicion of government programs and an assumption that anything run by the government is characterized by inefficiencies and graft,” he told me. “So the slashing of governmental programs rarely causes an outcry among evangelicals.”  

A person who was once involved in ministry described the mindset this way: “The government shouldn’t be doing this. Even if PEPFAR is a great program and saves millions of lives, it’s not the role of the U.S. government to spend the money obtained from the forcible confiscation of citizens’ property for the benefit of non-Americans. Reduce taxes, highlight the issue, and encourage Americans to set up and charitably give to NGOs that perform the same function.”

A minister in a church in Memphis told me it’s important to “recall that most evangelicals also originally viewed the HIV/AIDS issue as a result of sexual promiscuity, and gay promiscuity especially. So I suspect too many of them regard the HIV/AIDS crisis as a self-inflicted contagion. I can imagine the moralists saying, ‘They brought this on themselves. It’s God’s judgment on them for their sexual sin. And they shouldn’t expect me to pay for their meds.’”

Some of the opposition has very different roots. Tim Dearborn helped lead World Vision—an interdenominational Christian humanitarian aid, development, and advocacy organization—during the years PEPFAR was introduced. World Vision, along with the National Association of Evangelicals, Samaritan’s Purse, a handful of other Christian groups, the rock star Bono, who in 2004 co-founded the ONE Campaign, an advocacy organization focused on fighting extreme poverty and preventable diseases, particularly in Africa, and the preacher Rick Warren and his wife Kay, co-founders of Saddleback Church, worked tirelessly to convince evangelicals that AIDS was an issue about which they should care. But World Vision also encountered pushback. “The judgment that it was either a gay disease or the result of extramarital promiscuity fed evangelicals’ resistance and disinterest,” Dearborn told me. Despite its efforts to focus evangelicals on saving millions in Africa from dying of AIDS, World Vision had difficulty making inroads. “It’s never been a priority, even though women and children are often innocent victims who suffer and die from the disease,” he said.

Ken Casey worked at World Vision for more than 20 years. From 2001 to 2007, he led its global response to the HIV/AIDS pandemic. He pointed to more theological explanations. “Evangelicals tend to prioritize getting people to make a (one-time) decision to have faith in Jesus without giving sufficient attention to following Jesus’ commands to love God and our neighbors,” he told me in an email.

So there are plenty of explanations for why evangelicals have not spoken out against what is happening to PEPFAR, some of them far more understandable than others. But it’s still hard to ignore this fact: White evangelicals voted in overwhelming numbers to put into office a president who has, for now, decimated a program that qualifies as among the greatest health interventions in the history of medicine and one of the most humanitarian acts in the history of America. Millions may die as a result. And a religious movement that proudly advertises itself as pro-life, and which over the years has taken public stands on issues including abortion, same-sex marriage, pornography, critical race theory, the role of women in combat, school curriculum, and sports betting and gambling in all forms, has, with rare exceptions, said nothing about it.

A pastor of a conservative evangelical church told me he’s grieved by this. “I got exhausted by the sympathetic inaction,” he told me. “If a Democratic administration were doing this—callously, illegally and completely unnecessarily destroying a cause prayed for, advocated for, designed by and in many cases carried out by evangelical believers—I struggle to believe that the response would be any less immediate and strident than if they were to mandate states to permit abortion.” He added, “The gleeful destruction of USAID and careless discarding of lives, and the associated lies, are such obvious crossings of red lines, such blatant violations of a basic Christian posture in the world, that acting as though they are politics as usual actively deceives and disempowers our people, and we will have to deal with the cost of inaction as the projections become historical fact.”

Mark Labberton, the former president of Fuller Theological Seminary, has found in his work that many white pastors around the country see far fewer red lines in this moment than do pastors serving communities of color. “White churches and congregations seem tone-deaf to the raw pain and suffering so many are experiencing,” he told me. “When the social location of our gospel allows us to not see, to not hear, or to not care for vulnerable people, we fail the way of Jesus.” What gospel, he asked, are we prepared to live?

When Labberton became a Christian in the 1970s, he realized that his new faith wasn’t meant to be merely an add-on to his life, but instead, a faith that should reframe everything. That vision—in which hearts of flesh would replace hearts of stone, in the words of Ezekiel—seems at odds with the reaction of the evangelical world to the end of PEPFAR.

That PEPFAR should appeal to pro-life Christians feels like an obvious truth to those who know what it has accomplished. The award-winning Christian singer-songwriter Amy Grant performed last month along with fellow evangelical musicians at a church in Brentwood, Tennessee, to raise awareness of and support for PEPFAR. “I look at the conservative faith community and the word pro-life is said many times, and I go, ‘Whoa, there’s not much more of a pro-life effort than combatting HIV/AIDS worldwide,’” Grant said.

She was joined by Russell Moore, the editor in chief of Christianity Today. “PEPFAR should be an easy call for evangelical Christians,” Moore told me. “It affirms human dignity and the sanctity of life in ways easily within the reach and responsibility of our country. It is hard to know whether the glee for destroying one of the most effective and successful moral reforms American evangelicals have ever supported is more sadism, cruelty for cruelty’s sake, or masochism.”

President Bush, himself a Christian and self-described “compassionate conservative” who in 2003 explained that the moral foundation for PEPFAR was the belief that “everybody has worth, everybody matters, everybody was created by the Almighty,” put it this way a few days ago in a video praising the outgoing staff of USAID: “Is it in our interest that 25 million people who would have died now live? I think it is.”

“My longing is that my fellow evangelicals would sit down with the sheer, disproportionate statistics of the closing of PEPFAR,” Chris Davis of Groveton Baptist told me. “The cost is a minuscule sliver of federal spending that has saved more than 25 million lives to date. The lives that could be lost by shuttering the program exceeds the amount of lives lost to abortion each year in our country. If we could end abortion deaths in America for 0.08 percent of the federal budget, evangelicals would support it in a heartbeat.”

Davis is grieved by the sheer cruelty of abandoning PEPFAR. “It does almost nothing to address our national debt, it does nothing to transfer these lifesaving programs to other funding sources, and costs a potential of millions of lives per year,” he said. “To what end? For what great cause? This is the exact disregard for human life that animates our anger against abortion. So why are we not furious at this catastrophic loss of life?”

Answering that piercing question requires understanding the cultural politics that have shaped American evangelicalism over the past half century. There is a “cultural lens that people have that sits atop evangelical theology,” Michael Keller, a pastor at Redeemer Presbyterian Church in New York City, told me. It’s not the theology that explains the silence on PEPFAR; it’s “the cultural lens we’re using to parse how we engage,” according to Keller.

The problem is that in too many cases, that cultural lens has very little to do with the priorities of Jesus. People who have become “culture warriors” in the name of Jesus often validate their cultural politics by proof-texting the Bible. But proof-texting the Bible can lead to some very bad places, as we’ve seen throughout Christian history, when verses from the Bible were used to justify everything from genocide to wars, from anti-Semitism to slavery and segregation, from geo-centrism to attacks on evolution. In Luke 4, we’re told that Satan used the Bible—Psalm 91—to tempt Jesus, in what is surely the most prominent of the great proof-texting wars.

In 2014, World Vision announced that it was willing to hire Christians in same-sex marriages in the United States. The reaction was instantaneous, overwhelming, and ferocious. Prominent evangelicals and organizations denounced the Christian humanitarian organization for deviating from traditional Christian values. The charity lost more than 3,000 sponsors for needy children. Evangelical groups across the country called for a boycott. Prominent evangelicals such as Franklin Graham and Al Mohler attacked World Vision; Mohler referred to its decision as “a grave and tragic act.” Evangelical scholars called it a “betrayal.” The extraordinary humanitarian work of World Vision didn’t seem to matter; prosecuting the culture war did, even if innocent children were the collateral damage. Within two days, World Vision reversed its decision.

It’s a revealing comparison: A decision by a venerated Christian relief agency to hire Christians in same-sex relationships caused an immediate, angry, and explosive reaction across the evangelical world, while the decision to effectively end a program that has saved more than 25 million lives on the African continent barely registers. Few of those who are aware of what’s happening have anything to say about it. And many who are inclined to say something pull back, fearful of the consequences.

Because of the brazen cruelty of the Trump administration, we can expect there to be new murals of Jesus surrounded by children who died of AIDS in Ethiopia, new “Coffin Rows” in countries like Malawi, and fewer miracles like the one that saved the life of John Robert Engole. Evangelicals in America—for a dozen different reasons—have mostly turned their eyes away from what is happening on the African continent. They have other things to do. They have culture wars to fight.

Jesus knew such people in his time. They were religious figures who, when they saw that wounded traveler on the road to Jericho, passed to the other side.