By Leah Sargeant, leader of Other Feminisms, a substack community, and author of Building the Benedict Option and The Dignity of Dependence.

“Don’t have sex,” says the nervous health teacher in Mean Girls. “Because you will get pregnant, and die.” Sex carries the risk of both life and death, but neither our moral education of children nor our public health work at home and abroad should view rising mortality as a hopeful sign for promoting morality.

In her essay, “‘Save PEPFAR’ Goes Too Far,” Carmel Richardson raises concerns about the defense that social conservatives like me have offered for PEPFAR. PEPFAR, a federal program established under the administration of President George W. Bush, is estimated to have saved the lives of approximately 25 million people from HIV/AIDS. PEPFAR does this by distributing drugs that prevent HIV infection for vulnerable people (particularly babies born to HIV+ mothers) as well as medication that can suppress the virus in people already infected. When the virus is suppressed, HIV does not progress to AIDS and HIV+ patients can avoid infecting others.

Richardson’s concern is that, by lifting the HIV/AIDS death sentence, PEPFAR’s programs “have the effect of making otherwise risky sexual behaviors suddenly risk-free.” PEPFAR does not limit drug distribution only to married partners in serodiscordant pairings (relationships where one partner is HIV+ and the other is not). Rather, it also distributes drugs to those engaging in risky sex. Her concern is that PEPFAR has, as a result, “prepared the way for more incidence of sexual promiscuity, not less.”

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There is no disputing that PEPFAR takes a full coverage approach to fighting HIV/AIDS. PEPFAR sets a global 95-95-95 treatment target. That is the program attempts to make sure that:

95% of people with HIV are aware they are HIV+
95% of people diagnosed with HIV receive antiretroviral therapy
95% of people on antiretroviral therapy achieve viral suppression

PEPFAR has crossed the 90% threshold for these targets in many of the countries where it operates, and it has done so while working to transfer more of its successful programs to partner countries. But progress both toward expanding reach and standing up self-sufficient partners was upended by DOGE’s sudden, arbitrary cuts and stop-work orders. The 95-95-95 target is the standard for ending HIV/AIDS as a pandemic. When nearly everyone who is HIV+ is diagnosed, treated, and unable to transmit the disease, new infections will become rare. PEPFAR was on track to decrease new infections and AIDS-related deaths by 90% by 2030.

HIV cannot be eradicated—only two diseases, smallpox and rinderpest, have ever been completely wiped out in nature. HIV infects animals as well as people, which puts total elimination out of reach. But HIV can be eliminated as a pandemic and as a major cause of death, just as measles was. To do so requires serving everyone at risk, regardless of how they may be exposed to HIV.

How can we think about the tradeoff of saving lives but reducing the danger of sex? Take the whole question from the other side—was the emergence of HIV/AIDS a tremendous gift to human freedom and sexual integration because the danger associated with sex had gone up so severely? When antiretrovirals were discovered, when the disease was not a death sentence, should Christians have grieved the loss? Is the rise of antibiotic-resistant syphilis in America a sign of hope for relationships between the sexes?

Some of these may sound like a reductio ad absurdum, but I’ve heard friends raise similar worries about the HPV vaccine. The HPV vaccine is recommended to preteen girls because it almost entirely eliminates the risk of cervical cancer if a young woman is fully vaccinated before she becomes sexually active and is potentially exposed to the cancer-causing virus.

I was in the first generation of girls to get the shot. I plan to vaccinate my daughters. But I have friends who have asked in good faith whether going in for the shot will confuse their children—if you are asking your children to not have sex outside of marriage, then why are you also acting as though they might break the rule and lowering the cost of doing so?

The worry about HPV vaccines at home is consistent with Richardson’s worry about moral hazard abroad. When we meaningfully reduce the danger of sexually transmitted disease, are we encouraging or condoning riskier sex? I’m glad to make that tradeoff, at home and abroad.

There’s a trivial reason to prioritize the HPV shot (a young woman might choose to marry someone who did slip before marriage, and she won’t want to catch a cancer causing virus from her husband). But it’s not the only reason I’ll protect my preteen girls. My pitch to my children for sexual continence won’t sound anything like that of the Mean Girls coach.

The problem in America is not that sex is not dangerous enough. What all teens and twenty-somethings need is a clearer positive vision of marriage and sexuality. I want my children to understand eros as an invitation to both self-gift and to the natural cross and joy of welcoming children.

A sexual education that focuses on risk minimization will always find the risk of birth even more terrifying than the risk of disease. Because sex is ordered to children, there will never be fully “safe” sex. If sexual ethics are primarily shaped by fear and self-protection, abortion will always be the “safe” choice.

Sexual ethics depends on seeing the weakness and vulnerability of a potential child in the womb and responding with tenderness and awe, not fear or resentment. PEPFAR is part of the broader universe of pro-life work first because it directly protects children in the womb from the death sentence of untreated HIV/AIDS. Second, PEPFAR also strongly evangelizes against the throwaway culture that makes abortion and euthanasia acceptable and expected—a throwaway culture that takes someone’s weakness or illness as a license to kill or neglect them. PEPFAR nurses serve women who are vulnerable and help them protect themselves against disease and to avoid or escape sexual violence. It treats women’s health as an end in itself, not a resource for men to spend down.

It will take time to number the deaths due to the sudden paring back of PEPFAR. Researchers at Boston University estimate 176,000 preventable AIDS deaths in the first year of PEPFAR cuts alone.

On-the-ground reporting can already begin putting faces to the figures. Evan Anzoo was born HIV+ in South Sudan five years ago. PEPFAR and USAID kept him alive, and kept his mother, Jennifer, alive to see the miracle that he could rise and walk, with his disease held in check. That was, until this year.

Without access to antiretrovirals, Evan’s latent infection came roaring back. He died at five, the same age as my eldest child. He lived one hard week as an orphan, having lost his mother to her infection just before he followed her into death.

In the weeks following Easter, Christians give thanks that a pure, innocent victim went to His death willing to set us free from our slavery for sin. His death was and is sufficient. We have no need to allow children to be consumed as payment for or a warning against the sins of adults.

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Don’t Let the Grim Reaper Teach Sex Ed