By Dr. Perry Jansen, MD, MPH, DTMH
In the halls of Partners in Hope (PIH), a faith-based HIV clinic in Malawi, I was greeted by an old friend, Rebecca Tambala.* She looked healthy but shaken. She buried her face in my shoulder and cried, “Oh, Doctor, I’m so happy you’ve come. I don’t know what I’m going to do. I’ve been sacked.”
Rebecca had just lost her job as a patient attendant. Her position was one of more than a thousand eliminated after PIH received notice that its $17 million annual USAID/PEPFAR grant was being terminated amid the funding freeze caused by DOGE reforms. It was a devastating blow—not just to Rebecca, but to the 220,000 HIV patients PIH supports.
For nearly 20 years, PIH has been a trusted implementing partner of the U.S. government, delivering life-saving care in partnership with Malawi’s Ministry of Health. The organization grew from a modest clinic to a national force for HIV prevention and treatment, thanks to support from PEPFAR—the President’s Emergency Plan for AIDS Relief, one of the most successful U.S. foreign assistance programs in history.
I had the privilege of helping launch PIH in the early 2000s, and I’ve returned to Malawi every year since. In that time, I’ve seen firsthand how foreign aid transformed a country once on the brink of collapse due to HIV. And I’ve seen how one program—PEPFAR—gave people like Rebecca a second chance.
Rebecca’s story began as a patient. A single mother, she was dying from AIDS and tuberculosis. Her daughter, born before Malawi’s PMTCT (prevention of mother-to-child transmission) program expanded, was also HIV-positive. Rebecca responded to treatment and eventually recovered, though she remained trapped in poverty. When a low-paying job opened at PIH, she applied—and got it. Her work became more than a paycheck. It was a calling.
With her $100/month PIH salary, matched by another $100 from the government, Rebecca could send her children to school and keep them fed. Her second child was born HIV-free, thanks to antiretroviral prophylaxis. She became a vital part of the team—offering care with deep compassion because she had lived what her patients were going through.
When I saw her again this year, she had just finalized her separation paperwork.
The funding cuts were part of a broader push to eliminate what the administration called “waste, fraud, and abuse” in foreign aid. But PIH, like many other PEPFAR programs, was caught in the net. While I agree that reform was overdue, the execution was reckless. The sudden disruption of programs like PIH didn’t just trim bureaucracy. It fractured essential care systems and put lives at risk.
Thankfully, recent advocacy in Washington led to a partial reversal. PIH recently received a letter rescinding the termination. Under Secretary Rubio’s Humanitarian Waiver, the clinic will resume core HIV services. But rebuilding won’t be easy. It will take months to rehire staff, stabilize operations, and re-establish continuity of care. And the most fragile thing to rebuild will be trust—between funders and implementers, between governments and the people they serve.
The stakes are higher than a single clinic or country. Malawi is one of the ten poorest countries in the world, with an average annual income of just $464. Yet it has been a model of how global partnerships can work. U.S. foreign assistance has played a quiet but powerful role in supporting health, stability, and prosperity. PEPFAR has helped prevent the deaths of 25 million people globally. In Africa, President George W. Bush remains beloved for the gift of PEPFAR. The branding on many clinic walls still reads, “From the American People.”
But today, that legacy is at risk.
During this visit, I was struck by the overwhelming presence of Chinese investment in Malawi. China has built roads, soccer stadiums, the Parliament Building—even hotels. In contrast, the U.S. has built trust. Where China’s involvement is transactional, America’s has been relational, rooted in partnership and dignity. That trust has allowed American values to take root in places like Malawi. It has also helped secure long-term access to rare earth minerals and global goodwill—both essential to U.S. national interest.
This is why the new U.S. foreign aid approach—”Making America Stronger, Safer, and More Prosperous”—must recognize the strategic value of programs like PEPFAR. Rebecca’s story is not just about health. It’s about what happens when aid lifts a family out of generational poverty, strengthens a national health system, and helps a government become more resilient and self-reliant.
I now work with African Mission Healthcare, a nonprofit that supports PIH and other hospitals across Africa. When PIH’s grant was terminated, we stepped in with emergency funding to keep the clinic open and joined the advocacy effort to reverse the decision. PIH’s academic partner, UCLA, also raised emergency funds from a network of doctors who rotated through PIH in their training. However, private support can’t replace the scale and consistency of U.S. government investment.
As a doctor, I’ve seen lives transformed. As a U.S. citizen, I’ve seen how generosity can become strategy. I believe America can and should lead the world in smart, compassionate, and strategic foreign assistance.But we must not break the trust that has taken decades to build. We must finish what we started.