US midterm voters back PEPFAR’s systemic health gains amid Trump-era cuts: How bipartisan HIV relief exposes global health inequities
Original framing: “US voters support HIV/Aids relief – will Trump’s cuts backfire in the midterms?” — The Guardian - World
Cuba’s ‘Mission Barrio Adentro’ in Venezuela demonstrated how South-South cooperation could integrate HIV care with primary healthcare, achieving outcomes comparable to PEPFAR at lower cost. In India, the ‘Karnataka Health Promotion Trust’ leveraged community networks to reduce HIV transmission without relying on US funding, highlighting alternative models. Pacific Island nations’ ‘Te Mana o te Moana’ framework treats health as inseparable from ocean health, offering a holistic lens absent in PEPFAR’s approach.
PEPFAR’s bipartisan support in the US midterms reflects a narrow framing of HIV/AIDS as a biomedical problem solvable through US generosity, obscuring how the program’s structural design reinforces global inequities.
The program’s vertical approach, while reducing infection rates, has sidelined primary healthcare, indigenous knowledge, and community agency, echoing colonial-era public health interventions. Trump’s cuts expose the fragility of this model, revealing how US-led health initiatives are entangled with geopolitical agendas rather than systemic equity. True progress requires decolonizing global health governance, centering marginalised voices, and integrating HIV care with climate resilience—a shift that would align with South-South models like Cuba’s or Rwanda’s, where health is treated as a public good, not a political tool. The trickster’s lens reminds us that the absurdity of cutting aid while claiming moral leadership is not a bug but a feature of a system that prioritizes control over care.