Perhaps the most despicable of the character flaws of Donald Trump is his cruelty and his apparent enjoyment of the same!

In the last couple of years I have not thought much about the dreadful epidemic of HIV/AIDS that dominated my professional and clinical life for about 15 years, but that has changed as Trump disrupts programs that have successfully curtailed, though not eradicated, the spread of the virus responsible.

AIDS, an “Acquired Immune Deficiency Syndrome”, develops when one is infected with the deadly “Human Immunodeficiency Virus” which has the unique capacity to kill the only cells our immune system possesses that could defend us from this deadly foe. Their destruction destroys our ability to protect ourselves from a myriad other infectious agents. HIV, and those other infectious agents to which we become vulnerable, result in death, usually within 18 months of infection.

HIV infections most often occur during sexual activity as sexual secretions contain many T cells which could be carrying the virus. These cells are also plentiful in blood and breast milk.

My first encounter wth a patient with AIDS involved particularly distressing circumstances.

In 1983, I was working at Yale University in New Haven about an hour and a half drive from NYC. A young man was referred to my clinic with a years history of numerous infections and weight loss. He was no ordinary young man. He was a commercial pilot flying for American Airlines and was famous as he was the first man with haemophilia, a condition in which a missing factor stops blood from clotting normally, to be able to pursue his dream of being a pilot. The needed clotting factor had become available when scientists learnt how to extract and concentrate the factor from donated blood. Tragically, that donated blood was also susceptible to being contaminated with HIV.

I knew nothing about this possibility when I saw him, but there had been reports from NYC of a strange immunodeficiency developing among gay men who were having unprotected sex. It turned out my patient had been having unprotected sex with his fiancée and over a few months she also developed signs of immunodeficiency. As AIDS cases multiplied exponentially, a primitive test by today’s standards which allowed one to see if blood contained normal amounts of T cells became available and my couple, and by then many more patients, clearly had T cell deficiencies.

In the two years that followed before my return to Australia, my team at Yale fought to help more than 100 patients with HIV infections who came for help, all of whom died. AIDS is truly a horrible disease!

When I retuned home the epidemic of AIDS was devastating mostly gay men, but on the international stage there was a dangerously inaccurate belief spreading that AIDS was a Northern Hemisphere problem and few countries in the region were doing much about education or screening. Public discussion about sexual behaviour was difficult in many Asian cultures.

Alarmed, I established an organisation to tackle this issue (AIDS Society for Asia and the Pacific) and liaised with AIDS programs at WHO and UNDP. Soon the epidemic was sweeping through Asia and Africa. With help from the international agencies, I joined teams visiting Burma (condoms forbidden), India (60% of the prostitutes in Bombay HIV positive) Malaysia, Thailand (got the monks to distribute condoms) and the Phillipines. The death toll was staggering worldwide.

Despite huge international efforts, it was not until 1992 that a combination of two drugs was found that could suppress HIV and prevent progressions to AIDS. The drugs we have today don’t eliminate HIV, but stop the virus killing T cells as long as the drugs to prevent this are taken daily. We also now have drugs that can be taken daily by those who are not infected by HIV, but could be at risk of infection

Since the beginning of the epidemic, WHO analysis reveals that 88.4 million people have been infected with the HIV virus and about 42.3 million have died of AIDS

Enter the United States. In 2003, President George W Bush launched “The US President’s Emergency Plan for AIDS Relief (PEPFAR)” which has been the most important initiative focused on addressing the global HIV/AIDS pandemic. It has been overseen by the Bureau of Global Health Security and Diplomacy at the US Department of State. and has invested more than US$110 billion to date.

Through the distribution of anti-HIV drugs and a massive education campaign, about 40 million people are living with (not dying with) HIV. The WHO African region remains most severely affected, with one in every 30 adults living with HIV.

Enter Donald Trump. With a flush of his ludicrous signature he announced that he was abolishing the USAID effort in Africa with instantaneous dismissal of the 10,000 individuals employed to educate, guide and provide anti- HIV drugs. Funding for important research has been withdrawn including a promising study of a new drug that may only need to be taken twice a year to control an individual’s HIV infection.

Epidemiologists are now warning that there could be 5 to 11 million new HIV infections between now and 2030 and 800,000 to three million HIV-related deaths. Among children, we could expect an additional million infections and 120,000 deaths.

Trump’s enjoyment of cruelty demands decisions with disastrous instantaneous effects. You wake up in the morning thinking you have a job and a mission to continue, only to hear that your job no longer exists.

While international approbation for cruelty such as I have described is widespread, not one Republican voice has been heard criticising such actions. It is what it is and wealthy countries like ours need to hold urgent consultations to discuss how they can mitigate the suffering Trump is inflicting with such obvious pleasure.

The views expressed in this article may or may not reflect those of Pearls and Irritations.