Frequently Asked Questions About PEPFAR

a mean post

PEPFAR is a wildly cost-effective anti-HIV program, currently floating somewhere between life and death like a coma patient who forgot to sign a DNR order. If you’d like to know more about PEPFAR from a serious and fact-based perspective, I recommend reading pepfarreport.org, which was put together by some friends of mine and goes deep into the research.

However, over the course of many conversations on X, I have learned that absolutely no one’s real reason for opposing PEPFAR is addressed by boring “facts” and “numbers” and “PEPFAR saved about 19.5 million lives at a cost of about $3,600 per life saved.”¹ I wrote this post to address the real issues, dear to PEPFAR opponents’ hearts.

Why should the United States pay for PEPFAR when there are still problems at home?

Because our problems are expensive and hard, and giving people antiretrovirals is cheap and easy.

Why can’t poor Africans pay for their own antiretrovirals?

Because they don’t have any money.

Why can’t rich people pay for Africans’ antiretrovirals through charitable donations?

Because, while rich people have money, they’re spending it on $15 million dollar bribes to the descendants of Rich Person A so the Lincoln Center can rename one of its halls from Rich Person A Hall to Rich Person B Hall. I agree this is a problem and I also wish we could get rich people to stop doing this.

If PEPFAR is such an effective program, why do we have to keep paying for it?

If building roads is so effective, why do we have to keep fixing potholes? If Social Security is so effective, why do we have to keep sending out checks? If cleaning is so effective, why is it that if I stop tidying for six months my house is disgusting? If eating is so effective, why am I starving to death?

Why do I have to pay for poor Africans’ antiretrovirals when I don’t want to?

We all have to pay for some U.S. government programs we disapprove of. I have to pay for torture, immigrant children being separated from their parents, U.S. citizen children being separated from their parents, quack science that puts innocent people in prison, and so many fucking war crimes. And you have to pay for some of the world’s poorest people to get medicine. Really, we are both in an equally unfortunate position here.

Is PEPFAR wasting my tax dollars?

0.08% of the U.S. federal budget goes to PEPFAR. For the median American taxpayer, this amounts to $5. If you are in such dire need of an additional McDonald’s Value Meal, try underpaying your taxes by $5. I doubt the IRS would notice.

Is PEPFAR a liberal program made to subvert American greatness?

It was founded by notorious Communist George W. Bush for exactly that reason.

Is PEPFAR funding woke brainwashing overseas?

While 52% of PEPFAR’s budget is spent on antiretrovirals, it’s a little known fact that the vast majority of that funding goes to DEI operas about critical race theory and the importance of preferred pronouns, which patients are required to watch before filling any prescription.

Does Christian theology teach that PEPFAR is morally wrong?

Ten years ago, a cabal of shadowy New Atheists met with each other.

“Following our Satanic master’s command,” Richard Dakwins said, “we have almost succeeded at destroying Christianity, tradition, and morality itself. Soon, all humanity will sink into a slough of sin, degeneracy, and despair!”

“But there’s a problem,” Sam Harris said. “Whenever we’ve just about convinced everyone that Christianity is stupid and Christians are evil, they say ‘it’s admirable when Christians give to the poor’ and ‘Christianity might be false, but it makes people who believe it better people’ and ‘what about PEPFAR? You have to admit, evangelicals went hard about PEPFAR.’”

“Ah,” said Eliezer Yudkowsky, twirling his fedora, “but what if we got a crack team of the finest rationalists, trained in the Dark Arts of Rationality for years in a remote monastery, to infiltrate the Christians and convince them that giving to the poor is anti-Christian?”

Sam Harris’s mouth gaped. “But everything in the Bible—! Centuries of tradition—! They’ll never fall for it!”

“Christianity isn’t about the Bible,” Robin Hanson said. “Christianity is about signalling. Let’s do it.”

Won’t PEPFAR cause overpopulation in Africa?

Underpopulation is more of an issue than overpopulation, and usually, decreases in child mortality decrease fertility a similar amount. Regardless, if you believe that a good solution to overpopulation is people dying horrible and preventable deaths, you are welcome to go first.

Is the only reason that people have HIV that they’re having gay sex?

You’re right. The reason that 17% of Botswanans and South Africans have HIV is that people in those countries are just really, really gay. The three-fifths of people with HIV in Botswana and South Africa who are women are all former gay men who transitioned. Even the pregnant ones. Especially the pregnant ones. Africa is basically just the Castro blown up to the size of a continent. Grindr keeps going down there because their servers can’t handle the hundreds of millions of Africans who at all times are browsing it in search of cock.

Can’t people avoid HIV by taking personal responsibility for their actions?

Yes. All these babies are expecting the American taxpayer to pay for them not to get HIV, when they could have just thought ahead and put a condom on the umbilical cord. Make better choices, babies!

Can’t adults avoid HIV by taking personal responsibility for their actions?

Of course! Indeed, personal responsibility is such an important virtue that I don’t think it should just be limited to Africans. This is why I support the Personal Responsibility Act of 2025, which implements the death penalty for everyone who has sex outside of a mutually faithful monogamous marriage. Rape victim? Got cheated on? Need to sell sex to feed your family? Made a bad decision when you were sixteen? Just think sex is a valuable part of life you are unwilling to live without? DEATH. HIV may be under control in the United States, but no longer will this tragic fact keep heterosexuals from cultivating their virtue and self-control.

How could we possibly know that PEPFAR works?

A mystery.

1. Effective altruists: this is significantly cheaper than GiveWell because GiveWell includes health and consumption effects in its numbers and PEPFAR Report didn’t.