House Republicans are threatening a federal program that provides HIV treatment and prevention services to millions of people worldwide. Lawmakers must soon vote on whether to extend the program for another five years. But prominent conservatives are working to undermine it, claiming that it promotes abortion access (which they oppose) in the Global South—a claim the program’s supporters say is false.
The President’s Emergency Plan for AIDS Relief (PEPFAR) was signed into law by President George W. Bush (R) in 2003. For most of its existence, it has had bipartisan support. Its new status as a political bargaining chip could have severe global health ramifications.
According to the federal HIV.gov site, PEPFAR provides funding for services including HIV testing, PrEP and other prevention measures, and antiretroviral treatment. Through partner organizations in 50 countries, it trains health care workers and serves children and adults. The program has helped 20 countries contain HIV epidemic levels, or reach the international “90-90-90” benchmark of having 90 percent of people with HIV know their status and be on antiretroviral medication with the virus suppressed.
Because of the program, according to the government, almost 65 million people have been tested; 20 million receive antiretroviral therapy; and millions of HIV transmissions have been prevented. PEPFAR is credited with having saved 25 million lives.
The United States has spent around $100 billion on PEPFAR since 2003, and by law, it must be re-authorized every five years. This has so far happened three times: under Presidents Bush, Obama and Trump. This time around, the deadline for re-authorization is September 30. But in recent months, a small group of House Republicans have signaled they want to hold up or amend PEPFAR.
“The Biden Administration has misused the program as a well-funded vehicle to promote its domestic radical social agenda overseas.”
In May, the Heritage Foundation, a conservative think tank, published a report attacking how PEPFAR is operated.
“Weaknesses within its structure and approach have limited its impact and have begun to have harmful effects,” it states. “Worse, the Biden Administration has misused the program as a well-funded vehicle to promote its domestic radical social agenda overseas, as it has done with other foreign aid programs.”
The report accuses the Biden White House of tying the program to “abortion and the LGBTI agenda,” citing an unrelated January 2021 pledge “to support women’s and girls’ sexual and reproductive health and rights in the United States, as well as globally.”
The report includes no evidence that PEPFAR recipients are performing abortions. It merely cites statements from two organizations that criticized the Supreme Court’s decision to overturn Roe v. Wade—one from JHI 360 that supported “equal access to reproductive health services, including safe and legal abortion care”; and another from Jhpiego that said the decision undermined “the right of a woman wherever she lives to be at the center of her care and in charge of her sexual and reproductive health.”
The amendment would require PEPFAR to be reauthorized every year, instead of every five. Providers who can’t count on multi-year funding won’t be able to plan longer-term.
In June, Representative Christopher Smith (R-NJ), a member of the House Foreign Affairs Committee, was the first lawmaker to publicly attack PEPFAR, saying “President Biden has hijacked PEPFAR … in order to promote abortion on demand.” He cited the President’s 2022 PEPFAR action plan, saying it “makes absolutely clear that the new direction of the program includes ‘integrating’ PEPFAR with abortion promotion.”
That’s misleading. The action plan in question merely states: “Where possible, PEPFAR will integrate HIV programming into strengthened public health systems to manage … sexual reproductive health.” And a footnote added after the backlash reads: “PEPFAR does not fund abortions, consistent with longstanding legal restrictions on the use of foreign assistance funding related to abortion.”
The Helms Amendment, passed by Congress in 1973, means that the US government restricts any country receiving aid from using that money to provide abortions. What’s more, most of the countries that receive PEPFAR funding have strict abortion restrictions—some completely ban it.
Smith cites three PEPFAR recipients that he says provide abortion services or support access, but their use of US aid money would still have to comply with the Helms Amendment.
Ironically, Smith has in the past been a strong supporter of PEPFAR. He pushed for President Bush to adopt it in the first place, and worked to reauthorize it under Trump, comparing it to the Marshall Plan that helped rebuild Europe’s economy after World War II.
But with Republicans ramping up their attacks on abortion and LGBTQ rights, PEPFAR has now become a hostage of the “culture war.” The Heritage Foundation, together with anti-abortion groups including Susan B. Anthony Pro Life America and the Family Research Council, have threatened to give GOP lawmakers bad “scorecards” on abortion policy if they side with Biden on PEPFAR.
The future of PEPFAR is now in question. On July 12, Rep. Mario Diaz-Balart (R-FL), chair of the House Appropriations Committee, introduced an amendment that would require the program to be reauthorized every year, instead of every five. Advocates warn that this would make global HIV work worldwide much more uncertain, as providers who can’t count on multi-year funding won’t be able to plan longer-term.
“There are few programs that people can point to that are currently keeping over 20 million people alive. I’m not about to give up on that.”
If the program expired completely, it would be a devastating blow to global HIV eradication efforts. It wouldn’t necessarily mean the immediate end of PEPFAR; Congress could still appropriate money for it, even if potentially at different level. But the program couldn’t be updated to address current challenges, and certain provisions related to funding allocation, and oversight and transparency, would expire.
Democratic officials and some advocacy organizations have pushed back on the conservative claims, calling them false. A White House representative, speaking anonymously, firmly denied them to the Washington Post.
HIV/AIDS and public health organizations around the world—including Health GAP, the AIDS Support Organization, the ONE Campaign and the Kaiser Family Foundation—have also spoken out against amending the program.
Even some Republicans are standing up to the attacks on PEPFAR—most notably, George W. Bush, who earlier this year applauded the results of the program he passed in an appearance with former Secretary of State Condoleeza Rice.
Senator Bob Menendez (D-NJ), chair of the Senate Foreign Relations Committee, is among those who have promised to defend PEPFAR, and he’s reportedly working with Senator Lindsey Graham (R) to do so.
“We can’t reach our global goal of ending the HIV epidemic by 2030 through one-year increments,” Menendez told Politico, adding, “There are few programs in the world that people can point to that are currently keeping over 20 million people alive. I’m not about to give up on that.”