Trump admin may end PEPFAR, replacing it with a program chiefly benefiting the U.S.

The Trump administration has drafted a plan to end the President’s Emergency Program for AIDS Relief, a global health program estimated to have saved 26 million lives in developing countries since it started in 2003.

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PEPFAR “would be replaced by ‘bilateral relationships’ with low-income countries focused on the detection of outbreaks that could threaten the United States and the creation of new markets for American drugs and technologies,” The New York Times reports. The Times obtained State Department documents outlining the plan, which could go into effect in as little as two years in some countries. And even before then, PEPFAR would have a sharply reduced budget.

PEPFAR, which provides HIV-fighting drugs and other services, was started under a Republican president, George W. Bush, and it has often received bipartisan support. Donald Trump did not interfere with it in his first term. However, in recent years some Republicans in Congress have sought to end it, saying developing countries have become too dependent on U.S. aid.

“With targeted investment, PEPFAR’s H.I.V. control capabilities in these countries could be transformed into a platform for rapid detection and outbreak response to protect Americans from disease threats like Ebola,” the plan says, according to the Times.

“We believe that the transition of PEPFAR can become the premier example of the U.S. commitment to prioritizing trade over aid, opportunity over dependency and investment over assistance,” it continues.

“The documents assume a 42 percent reduction in PEPFAR’s current budget of $4.7 billion, which [Secretary of State Marco Rubio] has said is his goal,” the paper notes.

Related: 500,000 kids could die without PEPFAR as Trump & Elon Musk undermine HIV aid, study warns

A State Department spokeswoman told the Times the documents are not final and are “not reflective of the State Department’s policy on PEPFAR and was never cleared by Department leadership.” However, the plan has been in the works for several weeks, and the documents contain comments from senior officials with the program. Also, “word of it already has reached PEPFAR’s partners and governments in other countries,” the paper reports.

PEPFAR's funding was frozen earlier this year but was restored, although activists say it is still not functioning properly. And it is providing HIV prevention drugs only to pregnant and breastfeeding women under the Trump administration's policy, not to LGBTQ+ people.

Congress has control over PEPFAR’s budget, and it remains to be seen if it will go along with the plan. Congress and the executive branch recently agreed to restore $400 million in PEPFAR funding that was initially planned to be cut in the 2025 fiscal year. While the program has its critics among Republicans, it has support from some GOPers, such as U.S. Sens. Susan Collins of Maine and Lindsey Graham of South Carolina.

Asia Russell, executive director of HealthGap, condemned the plan. “This proposal is a death warrant, and countless people will die if it is allowed to go forward,” she told the Times.