Mark Labberton
I am delighted today to welcome Mindy Belz as our guest at conversing. Mindy is a journalist who has covered wars and victims of conflict in Afghanistan, Syria, Iraq, Sudan, and the Balkans. She recounts some of the tremendously painful and difficult military health and economic challenges around the world. Her work appears in the Wall Street Journal, the Plough Quarterly, and other publications. The New York Times calls her one of the bravest and best foreign correspondents in the country today. As we welcome Mindy, we do acknowledge that we’re facing one particular devastating decision of the new administration, which is the end of PEPFAR, the best response that the world has made to the devastating global HIV AIDS crisis. She’s written a recent article that she posted on her Substack, which is in the notes. It’s an article that simply highlights the history of PEPFAR and its incredibly positive life-giving, life-sustaining impact, not just in the past, but still currently. It’s this that we’re going to be focusing on in our conversation today. Mindy, welcome to Conversing. We’re glad that you’re here.
Mindy Belz
Thanks, Mark. Same.
Mark Labberton
I’d like to start with just a bit of your personal story. How did you get into journalism? How did you get into globally focused journalism, and what are some of the things that have been significant in your own faith and relationship to that vast and literally continuously and ending set of challenges?
Mindy Belz
Yeah. Well, it was about 30 years ago. It’s a long story, but I’ll try to make it short. Initially I got started writing for World magazine. I often say, because my brother-in-law started the magazine and he was desperate and he had me doing some writing. I had a background on Capitol Hill. I had studied international relations at George Washington University. So I just kept moving from one thing to the next, and suddenly there I am, covering the 10th anniversary of Chernobyl’s Meltdown in Belarus and Ukraine. And it just went on from there. And I did do, in the nineties, I was doing a lot of reporting, the late nineties in Africa, and was seen everywhere, absolutely everywhere you went. The effects of the AIDS pandemic, and I talk in the piece that I just wrote about, that you could not go into a hospital without seeing that it was overflowing with people who were dying of AIDS.
And there was a hospital in downtown Nairobi where you would walk down the hall, and you would thread your way past some of those victims, and there was very little that could be done for them at that stage. So I did a lot of reporting. I was there to cover conflict. I covered the conflict in Sudan and was in and out of Nairobi and Uganda quite a bit throughout East Africa. But then nine 11 changed everything. And I had begun. I had obviously, by covering the war in Sudan, I was seeing a lot of the conflict between Christians and Muslims, if we want to put it in those black and white terms, which that was very much a prominent feature of that civil war at the time. And also seeing the rise of Islamic extremism. I was passed by one of the Al-Qaeda camps at one point that was operating then in Sudan before they moved to Afghanistan. And it felt we were all talking a lot. Someone gave me a biography of Osama Bin Laden on one of my last, I think it was an early 2001 trip I made to Sudan, and nine 11 came, we had a war in Afghanistan. I began going to the Middle East more, and soon I was just going to Iraq over and over again and watching, learning much. You’re always an apprentice to this process,
Mark Labberton
Right? Yes.
Mindy Belz
And discovering Christian communities I did not know existed in the heart of the Muslim world, watching those communities be forced to flee their homes over and over again until we came up to 2014 and you had the rise of ISIS and they took over a third of Iraq and much of Syria. And I found myself going from initially getting into Iraq by crossing the Tigris River from Syria, and then suddenly I’m going to Iraq and crossing the Tigris River to get into Syria. As that war also began to continue and become tragic for many communities there. And I think that Mark, I learned early on something that, , I learned two things that I think were really unique and have driven my reporting. I was often entering a man’s world. I was often walking into one of the biggest faux PAs I made was walking into a room and very American sticking out my hand to shake the hand of a local shake.
And that was the wrong thing to do. I had to learn the rules of the road. I had to learn what it was as an American Christian woman to interact with Muslim men, to have them as drivers and translators and things that. And then one day it suddenly occurred to me I was taken away from some Muslim men I wanted to interview and taken to lunch with the women because I had to eat with the women. And I was pretty resentful of that to begin with because I was not going to get to talk to the important people. And then I had this beautiful lunch where I learned much about what these women’s lives were. And I suddenly realized I had this incredible privilege of being a woman, being a mother, and being able to enter into family life with people in these situations.
Along the same lines, I would go to the US military was doing press briefings in the green zone of Baghdad every day. And you go to these press briefings and learn nothing. And if you ask someone in the green zone about the craters that US bombs had created in the streets of Baghdad, is there a plan for fixing these people? This is an advanced society here where they have sewer and water, and I’m staying with a family out in Baghdad that has no water, no sewer, and is now dealing with three hours a day of electricity. And people in the Green Zone didn’t know about these things. And I had a moment where I left the green zone and thought, I’m not going back. And to say that my focus became not much what the headliners were doing in the middle of these conflicts, but how that people were surviving, how they were continuing to live. And I think about that a lot as a really important privilege perspective that I had because since that time, we’ve all experienced a pandemic. We’ve all experienced some of the conflicts in the world. We’ve all experienced some terrorism and violence and things that. And this is a part of life and a broken and fallen world. And learning from these, from women, from men, from children, incredible resilience in the face of terrible breakdowns is something that I just consider a real privilege of my work.
Mark Labberton
Right, right. It is an extraordinary thing to imagine that array that you’ve just painted swiftly and clearly about the devastation again and again and again and again and again and all these different settings that you’ve been exposed to. And while I know you were doing your job as a professional journalist and that you were capable, partly I imagine through that, to be able to cope with all of that you were seeing because you were there as a professional reporter feeling a responsibility to tell the stories. But how did you cope with the trauma exposure that you were having, and how does that still affect or not affect you as you go to these various places?
Mindy Belz
Yeah, it’s a little bit of a tender question. I think that I did have a lot of good training and a lot of good support for the most part on these trips. And that would allow me. I had a pretty strong, especially in the early days, strong idea of my job was to be a witness for those who couldn’t be there. And that gives you a certain responsibility to stand up and be brave.
In Sudan, probably around 1999 or 2000, we went into a village. I was with a local Sudanese NGO, and they knew that there were people who had just fled some fighting. It was a village I wasn’t planning to go to. I didn’t know anything about it. They didn’t know what we were going to find there. When we got there, we found people starving. We found people who were holding their babies scooping up water from just barely a puddle in a gourd and dripping water into their babies’ mouths. And the photographer who I had taken with me on this day said, I think you need to come over here. And there was a tiny child turned out, the mother said she was three years old, but she looked she was about six months old who was lying on a blanket and just a tiny bird with you could see every bone in her body. And they had laid her down because there was nothing more they could do for her. And she died of starvation that evening. It was a very hard thing. The photographer and I looked at each other, and I said, Take photos. And I began trying to talk to the mother, and it was a very, very hard and challenging thing. But those photos went on the cover of our magazine at the time. I think the first time, maybe the only time, I’ve gotten a call from the State Department asking me for the coordinates of where I was because it was a place that was very hard to find on any map.
And there were actually supplies flown into this area because that camp, we were just seeing a spontaneous camp. And that camp by the next week had tens of thousands of people in it, many of them in the same, there was a terrible outbreak of measles there. And there were groups that were actually able to get supplies flown in and to help them. But those are things that don’t leave you. And I think that for Americans, we always get to walk away. I’m really aware that in whatever hard situation I’m in, there’s a little voice at the back of my brain that’s saying, Don’t forget, you get to go home.
Mark Labberton
Mindy, thank you for giving us such a vivid sense of what your journey and your experience and your heart work, as well as your head work and your public work and your writing work all involves. I want to turn to this question of PEPFAR, and you’ve published just recently a really helpful summary of what’s going on with PEPFAR because of the administration’s decisions about ending PEPFAR support and Congress failing to act on the PEPFAR proposals that were before them. So I’D you to just very briefly summarize again what PEPFAR is, how significant it has been in its help, and what the meaning of this sudden abandonment of our commitments is going to cause.
Mindy Belz
PEPFAR is the president’s emergency plan for AIDS relief, which was passed by Congress instigated, I should say, by President George W. Bush in 2003, what I think many people would call the height of global pandemic in HIV AIDS prevalence, HIV AIDS deaths, etc.. And in the time that the programme has been around, it was an incredible lift. It authorized up to about 5 billion a year in funds that would be used to treat HIV AIDS across the globe in about 50 to 60 countries that varied year by year. I think what’s really significant is that it was the first time that the United States had committed this funding to battling a single disease. It was trendsetting, and it strengthened the UN programs that were battling AIDS. It strengthened European programs that were battling AIDS. It also put a level of just elevated the platform to the degree that it became a healthcare priority around the world.
And keep in mind that AIDS had become something that was almost 100% fatal as drugs came on the scene that we’re not curing the disease, but we’re suppressing the virus to the point that people no longer experienced the kinds of symptoms that were leading toward usually death that would often come from other things from secondary things. And the drugs were suppressing the viral load. Once that happened, it quit spreading quite as fast as it normally would. So this is just to give you an idea of the level of complexity. And this is something that has come to a point. We know that in the area of fighting epidemic pandemic-type diseases, when we stop talking about them, then we must be doing something right. And I think until the move by the Trump administration, most people probably didn’t think about, a few people would know what PEPFAR was.
They weren’t thinking about the fact that the United States was underwriting this global programme. But keep in mind, we still don’t have a real cure for HIV, and therefore, we are in this situation of constantly having people on medications that will suppress the ability of IT to translate into a deadly disease and the ability of it to spread widely through populations. This is a heavy lift programme that has continued since that time. And the complexity is, I’m struggling to figure out how to even explain what the dismantling does because the dismantling, when the Trump administration began slashing contracts that it had with its partners where these funds were going around the world, it was done entirely indiscriminately. And we had the total shutdown of USAID itself, the agency where many of the funds, but PEPFAR was a wide ranging programme.
Some of the funding went through the State Department and USAID, some went through HHS, and some even went through the Department of Defense. This was just the programme that it was. And suddenly, you had almost all of it pulled back. And I would also go back, and I should have said this at the beginning, to say that Congress had reauthorized this program multiple times. I believe four, but I’m not a hundred percent sure on that. But they had revisited it. They had shown oversight over it. There had been hearings. And increasingly, whereas in the beginning, this was a programme that conservatives and liberals were largely on board with because it had something in it for each one of them. Over time, it became something that conservatives were challenging, and they did because they were saying that it was not pro-life enough was the latest.
There was a real reauthorization battle in 2023, but it did pass, and it passed after extensive oversight by Congress. So in this, it’s important to say that right now, the situation you have is that the Trump administration has basically shuttered the program, and they have done so without the oversight of Congress, without revisiting this in any way. And Congress, as we have seen since President Trump took office, has shown no interest in exercising oversight. A reauthorization deadline came two weeks ago, and it came and went, and there was no agenda item in Congress to take this up in any way, reauthorize it, or move forward with some orderly closure. The medical issues are very complex because you have 20 million people who are currently taking antiretroviral drugs that are funded under PEPFAR, and many of those people just suddenly could not have access to their medicine.
And that means that we are watching, even now, the disease grow. And that’s going to be different wherever you are. It’s going to look different. I think Nicholas Kristof in the New York Times wrote about a young man who, even though he was on the drugs, was still very sick, and soon after coming off of them, he died. And the calculation, I did look at several different sources, and they all agree that the death toll from this decision and the shuttering of the clinics and the funds that support them with a year’s time could be 1.6 million people.
Mark Labberton
That number is just staggering. That’s more than the number of people who have died in US military conflicts since World War II, including World War II. Up to today, we have lost fewer people than this 1.6 million in one year through HIV AIDS deaths. It has to be said and is important for anyone that’s taking this up seriously. Of course, no one is against the idea of government evaluation and of appropriate discipline and of self-regulation that where there’s violations of anything, all of that needs to be called into question and set right, even in relationship to the charges that supposedly PEPFAR funds were being used to fund abortions, as far as I’m understanding, there was one instance of that. It came to knowledge through the very mechanisms built into PEPFAR that called it out, that corrected the circumstances that repaid the funds. And it’s not an established fact at all that there is rampant use of funds beyond the original intention, of course, of PEPFAR treating HIV AIDS
Mark Labberton
Patients. That’s right. So the devastation, the scale of the devastation is really quite mind-bending. Furthermore, it’s also really difficult to figure out, and here’s where I’m hoping you can give us at least some of your perspective and suggestions. It’s very hard to figure out what people who care about this can actually do in this time. They can certainly write to their congressman representative and explain how important the issue is and hoping that the PEPFAR will matter, will be revisited, etc.. And there is, I suppose, a theoretical possibility that’s going to happen. It seems very doubtful that that’s what’s going to happen, especially when it’s part of the shutting down of USAID in general and already the decimation that this has caused to a lot of clinics. But what can we do? I think your Substack article does a great job of distilling the critical issues that are involved in the numbers of people that are being touched. What now, Mindy, when you think about this situation? What are the pathways forward?
Mindy Belz
Yeah, I think the what now question is the extremely difficult one. And not only does it only affect the PEPFAR program and people who are living with HIV right now around the world, it affects many of the issues that we’re seeing where agencies are suddenly shuttered, where deportation seem to be happening at a rate above and beyond criminal cases, which is what we were led to believe would be the initial target. So I think that there are two running levels for answering this question. And the first is, yes, I think it is helpful to be contacting members of Congress, elected officials, the healthcare committee, the health oversight committees and that thing. And I think also, we all know candidly that that seems to be of little value. We have a Congress that is just not exercising its own proper oversight responsibilities right now.
But I want to think that we’re maybe not even in the middle of something. We’re maybe just at the beginning of something. And I think we all have to figure out how we work through the long-term battle that we are in around how we do government, how we do information, how we sort through the role of government. And one of the things that people will say about, and there’s a lot of education and a lot of conversation that has to happen. And those things can happen at our dinner tables. They can happen with our neighbors, they can happen with our local officials too. My own congressman, my own Republican congressman, was one of, I think, two or three who held a town hall over the last couple of months. And that was a very useful forum for bringing up all kinds of issues. And this would be one of them.
I simply think that in the sea of all of these changes, government changes that we’re seeing right now, we all have to decide which are the ones that, and I as a journalist have to decide which are the ones that are critical. And as I saw this 1.6 million figure and then heard the physician researcher at Johns Hopkins who I quote in the article, give this astonishing picture of it, it made it a critical issue for me. And he said, if a person is entrusted to care for a building and decides to tear it down, there’s a moral imperative to disclose whether there are people inside. There are 20.6 million people and 566,000 children living inside PEPFAR. And that, again, just to underscore the magnitude of it, and then to begin to have what may feel like they’re not conversations or actions that are going to have an immediate effect, but for all of us to understand as Americans, what is the role of our government?
Is it a government of the people by the people and for the people? And therefore, do I know what I need to know to be a good citizen, to be in that conversation? And I think that most of us are finding, I think most Americans, I had the privilege of being in Africa, and I’ve seen the bad side of the HIV AIDS pandemic, but I’ve also seen PEPFAR working and working incredibly routinely and in lifesaving ways. Most people don’t get to see that, but we need to know about it. I see these comments, even comments to the story that I posted. Well, the US can’t be doing charity. Well, what’s charity? And it’s such an overstatement to just simply call this charity. This is about raising the level of good health around the world, and that has economic value, that has national security value. And I dare say that many of the people who are saying these things could not have told you what PEPFAR was two weeks ago. And I think we all are being forced to be pulled out of an urgent, chasing the tail of a dragon mindset and taking steps back and being more thoughtful in how we approach these issues and how we talk about them is to me maybe feels not doing enough, but it is where we have to begin.
Mark Labberton
Well, I think you’re right. That is, I think given the circumstances that we’re facing on this front and on many other fronts, it’s about a long and agonizing process of conversational change and of where a place for understanding a moral conscience by America in relationship to the wider world. And certainly God doesn’t need the United States of America and God’s compassion and mercy and justice sometimes intersects with life in America, and it sometimes doesn’t, depending on who you are and what colour skin and what gender you may be and what your sexual orientation may be, all these things are things that I believe God cares very deeply about. And yet, certainly as a nation among nations, the thought that we want to be a moral nation suggests to me that we are needing to call our nation not to a Christian identity, which I think is the false attempt of Christian nationalism, but to a moral identity that people of faith, little faith, no faith other faiths can enter into and share.
And I think some element of that has been operational in the United States for a very long time, and now all of that is being dismantled and being labeled, as you say, by a really cheap word charity, as though there’s no wider frame than simply compassionate sentimentality, as opposed to something that’s really taking the moral realities of the world and all of their urgency seriously, and not pretending that we need to be as we’ve sometimes tried to be as a nation, the healer of the nations, but to say that we should actually be a force for taking these issues with great national seriousness and not just repudiating it because it’s not inside the boundaries of our own country.
Mindy Belz
One of the things that’s really unique about this particular programme too, the PEPFAR programme, is that I think one of the reasons that many were on board with it in the beginning is that it was seeking to do something quite novel at the time, which was to use the influence and the economic force of the United States to fund local programs. And the genius was that distribution of drugs would happen not in some nationwide campaign because that was going to be unworkable,
By locating in the specific areas where the HIV AIDS prevalence rate was located, local clinics and, in many cases, local NGOs that included churches. And there were significant, one of the first of the PEPFAR funded sites that the first lady, Laura Bush, and I believe the president two visited, was in Uganda, and it was a church run site. And you’ve had this incredible partnership. And I think that that is harnessing what you’re talking about, the aspect of flourishing and pude that is the United States. And I feel we’ve lost that. I feel we’re having these conversations as though we’re not the wealthiest nation in the world as though we’re not the most under text nation in the world as though as though we’re not one of the freest economies in the world where we can make these choices and say, we have the resources to go and make a difference in this situation.
And by doing that, we set an example for others to do it. And there has been this long trajectory of PEPFAR moving resources into local communities, and by bringing those people along, training new levels of healthcare workers, it’s five year, there were all these goals set up for 2030, at which point they would be turning lots of this programme over to local authorities. At that point, the United States, the US allocations of funding for PEPFAR had been flat for over a decade. You could argue that they’re a lot, but on the scale of what healthcare programs cost and a programme of the scale, 5 billion a year in 50 some countries is not a lot. And it had been flat. It had never gone up, and it would probably be starting to scale back after 2030. But with success, and I feel we have adopted an attitude of scarcity and pulling in and not seeing ourselves as people who are able and equipped to give hope and to give real healing to other parts of the world. And I think it will do something to us that we have become this way.
Mark Labberton
It was a number of years ago before PEPFAR that I made a trip to Uganda, and while I was there, I was visiting people with HIV AIDS among others, and about two or three years later, I was back in the same village and meeting with a group of people as I had done in the previous trip. And I didn’t realize, and they deliberately kept it from me, that the people in this one group were the same people that I had met pre-antiretroviral drugs,
And I had pictures in my mind, which I’d kept vividly in front of me, of what that first group looked like. And when I came into the second group, these were not those people because the earlier people were really in the process of dying, and you could just visually see this. And I remember them being astonished that, for example, that my colleague and close friend David Z and I went around and shook everyone’s hands and prayed for them. They were surprised that that had happened because, at the time, there was still that skittishness around how HIV transmission actually happens. So when I came back three years later, they had all had the benefit of antiretroviral drugs, and they were all the same people. I held up the picture that I happened to have with me, and it was the same crowd, but their life had been given back to them.
Mindy Belz
Amazing.
Mark Labberton
It was just an unbelievable contrast. So part of what I think I experienced emotionally in this time is just the taste that I’ve seen directly in many places in the United States, I will say, as well as in places internationally for the impact of these drugs and how it really is back from the jaws of death that people are being aided by these drugs and to suddenly cut them off. It is just really, really an act of cruelty. And even if it was thought to be necessary with no runway of a declining anticipation of this happening at a certain date and with certain planning and other things, we would just have a radically different moment. But that’s not what’s happening. It’s just off with everyone’s heads in one fell swoop. And it just seems extraordinary.
Mindy Belz
And I do think there are a lot of conversations around who can step in the gap, and yes, churches and civic organisations can step in the gap. Yes, foundations can provide antiretroviral drugs, but I think two things about this is just understanding that this is a system we’re not talking about. It’s not just medications, and the wheels are already off of the system. They begin to come off the minute that the funding stops because the funding comes through on a constant basis that makes these things possible. The reimbursements come through. So, there’s that. The other thing is the question of how. I don’t think that the question can be taken off of the government here. And the accountability and the oversight issue here is that if we are suddenly saving 5 billion a year or something close to it, where’s that going? What’s it going to be used for? And those are the questions that we just are not getting the answers to right now.
And again, the oversight responsibility of Congress comes into really serious question here, because if these things are all happening by executive decision and Congress did not have a meaningful role, then essentially the people are cut out of the conversation and we don’t know where the money, we once knew where the money was going, but we don’t know where it’s going right now. Even the money that we allegedly are saving. And there are just real and serious quite even if we see that many people will step up and that in some places these programs will be able to continue, the State Department did reverse itself as it has on a number of these development type grants and disbursements. And they did reinstate some hospitals, some clinics that are doing, I know one that treats 5,000 HIV patients, but many of them are still have gone away and they have gone away it sounds for good or at least for this period of time. And then there will be the rollback in terms of health that will affect other things because HIV is people who become sicker with HIV will become more likely to have tuberculosis, more likely to be suffering from other diseases and side effects of the virus itself.
Mark Labberton
Which is how most HIV deaths occur. Yeah, it’s really an extraordinary story. Mindy, this is a big question for anyone. So I’m not laying this at you because I think you’ll have some cosmic answer to this, but I know that many people who are suffering with the suffering of many other people right now are just wondering, where is the hand of God in this, or where is God helping us in this? How would you respond to that question?
Mindy Belz
Yeah. It’s hard to see where the hand of God is in it, and I think we can be honest about that, that we just don’t see where the hand of God is in it. And then I also go back to what we talked about at the top here about just seeing the incredible resilience of other people. And I think this is a real time. I am learning much from the stories of perseverance of many communities in the United States and abroad, the perseverance of the African-American community in the United States for centuries under slavery, under Jim Crow laws, under just incredible pressure and terrible oppression. The way in which African communities have faced poverty and have learned to care for one another and have cared for one another in sickness and in terrible situations of war. Hunger is also something that we can learn from. The communities that I’ve seen in the Middle East have suffered terribly from the wars of recent years and the way in which they just keep on leaning into one another. There’s a wonderful NGO that runs schools in Iraq, and they’ve been there for just decades. And at the height of the war, their slogan was, it’s a dangerous world. Go anyway. And I love that because I think it’s a dangerous time right now. It’s a very unsettling time, and we have to, on some level just know that, well, God is in this because other people have been through hard times and other times and they saw the hand of God, but when we don’t see the hand of God, then we just have to go anyway, and we have to trust that the hand of God is there and that it will meet us in the midst of those hard situations.
Mark Labberton
Amen. Thank you, Mindy, for being our guest on Conversing today. And thank you for following this story and continuing to lift it before us. I hope that anyone who’s listened to this will again visit her recent article about the 1.65 million people that are at risk because of cutting off PEPFAR support. This has been an important conversation, an urgent question and concern, and just an example of the investigative journalism that we really need to hear the most important stories. And surely this has got to be one of the most important ones. Thank you again very much for being here.
Mindy Belz
Thank you, Mark.
