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Just one program managed to survive the Trump administration's most recent attempt to cut foreign aid. Last week, lawmakers agreed to claw back billions of dollars they had previously allocated for foreign aid and for public media, but their exception was PEPFAR. That is President George W. Bush's emergency plan for AIDS relief. NPR's Gabrielle Emanuel reports the program has been saved for now, but its future is uncertain.
GABRIELLE EMANUEL, BYLINE: These days, Kenneth Ngure likes to use a metaphor to describe the global effort to overcome HIV/AIDS. He says it's like a big airplane, and he's looking at the in-flight map.
KENNETH NGURE: And then you can see your destination, so we're - everything is moving smoothly.
EMANUEL: Ngure is the president-elect of the International AIDS Society. The destination of the plane, he says, is a world in which AIDS is no longer a threat. He says that destination had been in sight, thanks to PEPFAR acting as the pilot.
NGURE: The pilots - they are the drivers of the control of the HIV pandemic because they put in enough resources.
EMANUEL: Resources that add up to $120 billion over the last two decades. The results of all that money and effort - 26 million lives saved, a plummeting HIV infection rate and rebounding of life expectancy, especially in Africa. Then, Ngure says, came Trump's inauguration, when he halted almost all foreign aid.
NGURE: It hits turbulence, and you start losing altitude, and you don't know whether we are going to get to our destination.
EMANUEL: He says, people have already been hurt by all the turbulence. In many countries, people lost access to their HIV treatment. For example, in Mozambique, a recent study shows that 40% of children on HIV treatment saw the virus surge back as their course of medication got interrupted by cuts to foreign assistance.
Last week, when Ngure heard Congress was plucking PEPFAR from Trump's funding clawback, he says it felt like the pilot coming on the loudspeaker with a reassuring message.
NGURE: There is hope, but still maintain your safety belt.
EMANUEL: Keeping your safety belt fastened is a wise approach, says Georgetown University's Charles Holmes.
CHARLES HOLMES: I don't think the program is out of the woods yet. It is a time of such great uncertainty.
EMANUEL: Holmes was the chief medical officer for PEPFAR in the Obama administration. He says preserving this year's funding is great, but...
HOLMES: The president has proposed major funding cuts for next year.
EMANUEL: Even if funding comes back, Holmes says, a key question is what that funding will go to. Under President Trump, so far, the vast majority of HIV prevention work has stopped, as has support for millions of AIDS orphans.
HOLMES: Without prevention and without care for orphans and vulnerable children, PEPFAR will be much, much diminished.
EMANUEL: Last week's move by Congress to spare PEPFAR funding has left some feeling more confident. Susan Hillis led PEPFAR's faith-based work under the first Trump administration.
SUSAN HILLIS: I think we're beginning to see a glimmer of, yes, it's possible to move forward in the same direction together.
EMANUEL: Hillis has been meeting with lawmakers, and she says people are starting to agree on some things, like not shutting off lifesaving support overnight but instead working with countries to wean them off PEPFAR money gradually.
A spokesperson for the U.S. State Department wrote in an email that PEPFAR will continue, but it, quote, "should be reduced over time as it achieves its mission." And a State Department planning document acknowledges support for prevention methods to avoid new infections.
Susan Hillis says, what the next version of PEPFAR will look like is still an open question, but she hopes, wherever it lands, it will be able to match the successes of its past.
Gabrielle Emanuel, NPR News. Transcript provided by NPR, Copyright NPR.
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