The U.S. official leading the nation’s response to the global H.I.V. and AIDS crisis says that Americans should be proud of the fact that its investment in global health has saved 25 million lives over the last two decades, and he praised faith-based organizations for their contributions.
Ambassador John N. Nkengasong was confirmed to the post of U.S. global AIDS coordinator by the Senate in May 2022. A year later, Secretary of State Antony Blinken and Dr. Nkengasong created the State Department’s Bureau of Global Health Security and Diplomacy, which is also home to the U.S. President’s Emergency Plan for AIDS Relief, known as Pepfar.
Launched by President George W. Bush in 2003, Pepfar has invested more than $110 billion in global health, and the program is credited with saving more than 25 million lives. According to the Kaiser Family Foundation, about 39 million people live with H.I.V.; and since the start of the AIDS epidemic more than 40 years ago, tens of millions of people have died from AIDS-related complications.
In an interview with America, Dr. John N. Nkengasong praised the work of faith-based organizations in helping to implement the U.S. President’s Emergency Plan for AIDS Relief, known as Pepfar.
Since its inception, Pepfar has enjoyed broad, bipartisan support from Congress. But in recent months, some Republicans have questioned the program, alleging that it is being used to promote abortion overseas. Supporters of the program said this is not true and have urged lawmakers to approve the continuation of Pepfar and to continue funding it, especially as fallout from the Covid-19 pandemic threatens progress.
In an interview with America, Dr. Nkengasong praised the work of faith-based organizations in helping to implement Pepfar. He said the program is “doing God’s work,” pointing to the story of the Good Samaritan. Born in Cameroon, Dr. Nkengasong is the first person of African origin to lead the U.S. government’s signature program fighting H.I.V. He spoke to America on Nov. 3, ahead of World AIDS Day, observed on the first day of December since 1988.
“Faith-based organizations have been there, before Pepfar, have played a critical role in advancing the goals of Pepfar since the beginning, 20 years ago, and they will continue to do so,” Dr. Nkengasong said. “They are really key players on the ground as part of the community, because they are really embedded in the community, they have the trust of the community.”
Pepfar works by helping prevent people from getting infected with H.I.V., providing access to life-saving drugs if they become infected and by serving those whose lives have been upended by AIDS, such as widows and orphans.
“If we look at that spectrum, as a whole, faith-based organizations play a critical role, and have been playing a critical role, in prevention, in care and in treatment.”
“If we look at that spectrum, as a whole, faith-based organizations play a critical role, and have been playing a critical role, in prevention, in care and in treatment,” Dr. Nkengasong said, pointing to Catholic Relief Services as a key provider of care.
Organizations affiliated with several faith communities partner with Pepfar, but Dr. Nkengasong identified the Catholic Church as “the engine for catalyzing the focus in addressing H.I.V./AIDS in children.”
He pointed to a series of meetings hosted by the Vatican, some of which he has attended. Last year, Pope Francis appointed Dr. Nkengasong to the Pontifical Council for Life, but he will not be able to accept the position until he finishes his job at the State Department, he said.
Dr. Nkengasong said that people of faith should be proud of the work that faith-based organizations do in addressing the H.I.V. crisis. He pointed to the story of the Good Samaritan, saying that each time he reads the Gospel passage, “it reminds me of who our neighbor is, and that we should be our neighbor’s keeper.”
“The question that we wake up everyday and ask ourselves is, ‘If we do not do this, what will happen to the people that we are supporting?’ Not, ‘If we do not do this, what will happen to us, as Americans?’” he said.
Our neighbor, he added, are “those poor people in Africa [who] are suffering from H.I.V./AIDS. If we abandon them, they will continue to suffer.”
“It is God’s work that we are doing,” Dr. Nkengasong said. “We should truly be very proud of that spirit—that through Pepfar, the world has seen us, seen our values, that we are a caring country, we are a caring people.”
When it comes to the United States helping other countries fight H.I.V., Dr. Nkengasong said the impetus is two-fold. There is the moral component, he said, but there is also a national security angle.
“But looking forward, H.I.V./AIDS is not over,” Dr. Nkengasong said, “far from over.”
“When you have a disease that is affecting the military, affecting young people, and the economy is not growing, it breeds hopelessness and helplessness, and that becomes an immediate threat to us,” he said. “It becomes a fertile ground to recruit the bad guys that become dangerous to everybody.”
Dr. Nkengasong said it is important to reflect on the progress made in the fight against H.I.V., which has killed more than 40 million people since the start of the pandemic in the 1980s, according to the World Health Organization.
“But looking forward, H.I.V./AIDS is not over,” he said, “far from over.”
Last year, U.N.AIDS reported that about 1.3 million new cases of H.I.V. were recorded, with more than 650,000 people dying from AIDS related complications. Dr. Nkengasong said adolescents and young adults still make up a startlingly high percentage of new cases, in part, he said, because they do not remember firsthand the horrors of the early days of the crisis.
“We have to stay committed to finish the fight against H.I.V./AIDS,” he said. “Otherwise, the gains that we’ve made over the last 20 years will be eroded. I think the gains are fragile, and they can easily be reversed.”
Over the past few months, some conservative political leaders have said that Pepfar needs greater oversight, with one influential think tank even suggesting that the United States cut the program’s funding in half. That debate prompted some Republican members of Congress to withdraw their support for a five-year reauthorization of the program, the first time in Pepfar’s 20-year history that a long-term extension has been in serious jeopardy. Some nonprofits, including Catholic Relief Services, have said that without a multi-year commitment from Congress, it will be difficult to plan their life-saving work.
“The need for reauthorization is so important,” Dr. Nkengasong said.
Pepfar has adopted a strategy of “localization,” in which the United States empowers local nonprofits and governments to take charge in responding to the H.I.V. crisis. And that kind of strategy could eventually lead to conditions in which U.S. involvement is no longer necessary. Some countries are eager to tackle the problems themselves but need assistance now, he said.
That means the United States still has a vital leadership role to play, and talk of withdrawal harms both the nations trying to fight H.I.V. and the individuals who receive their treatment through Pepfar-affiliated partners.
“We should always remember that if we do not reauthorize Pepfar, then we are signaling a kind of withdrawal,” Dr. Nkengasong said. “Then the question becomes, what happens to all the investments that we’ve put into Pepfar over the years?”
