One of the developments associated with the ascendancy of President Donald Trump is the paring back of foreign aid, in the context of a rampaging disembowelment of governmental bureaucracy and human infrastructure through the agency of the Elon Musk-led Department for Governmental Efficiency (DOGE). The two most visible entities at the centre of this dramatic change are the United States Agency for International Development (USAID), and the President’s Emergency Plan for AIDS Relief (PEPFAR).