After two decades of bipartisan support, a U.S. program that has saved tens of millions of lives by providing health care and medication to combat AIDS globally is at risk over Republican lawmakers’ opposition to abortion.

What You Need To Know

  • First established by President George W. Bush in 2003, the President’s Emergency Plan for AIDS Relief (PEPFAR) has saved tens of millions of lives across the globe and has continuously been renewed by four presidents and ten Congresses

  • Funding for the program was not included in the last-minute, stop-gap funding bill passed by Congress and signed by Biden over the weekend to keep the government running for the next 45 days

  • While PEPFAR is barred from directly funding abortion services, some organizations who receive funding through the program for other services also provide abortions, angering some Republicans

  • Staunchly anti-abortion, Bush himself called for Congress to “reauthorize PEPFAR for another five years without delay” and dismissed concerns about organizations funded by the program also providing abortions
  • “The reauthorization is stalled because of questions about whether PEPFAR’s implementation under the current administration is sufficiently pro-life. But there is no program more pro-life than one that has saved more than 25 million lives,” Bush wrote in a Washington Post op-ed last month

While the President’s Emergency Plan for AIDS Relief (PEPFAR) is barred from directly fund abortion services, some organizations who receive funding through the program for other services also provide abortions.

“HIV/AIDS infections and deaths plummeted in no small part because of PEPFAR’s work in more than 55 countries, saving more than 25 million lives,” President Joe Biden said in his address to the United Nations General Assembly last month. “It’s a profound testament to what we can achieve when we act together when we take on tough challenges and an admonition for us to urgently accelerate our progress so that no one is left behind, because too many people are being left behind.”

Funding for the program was not included in the last-minute, stopgap funding bill passed by Congress and signed by Biden over the weekend to keep the government running for the next 45 days. State Department spokesperson Matthew Miller said at a press briefing on Monday that “in the short-term” the program would be able to continue providing care, but did not have a specific timeline for how long it could survive before money dried up.

Representatives for the State Department, which oversees PEPFAR, did not immediately respond to an email from Spectrum News asking for clarification on when the funding will lapse.

The United States has poured over $100 million into PEPFAR since it was first established by President George W. Bush in 2003 and it has continuously been renewed through four presidential administrations and ten Congresses.

But on Thursday, the House GOP passed a State Department budget bill that would fund PEPFAR for just one year and included additional anti-abortion provisions, including barring the U.S. from providing any funds set aside for global health assistance to “any foreign nongovernmental organization that promotes or performs abortion,” with exceptions for rape, incest and danger to the life of the mother. It is unlikely to pass the Democratic-controlled Senate or be signed by Biden.

“Regrettably, [PEPFAR] has been reimagined — hijacked — by the Biden Administration to empower pro-abortion international non-governmental organizations, deviating from its life-affirming work,” Chair of the House Global Health Subcommittee Chris Smith, R-N.J., said on the House floor prior to the vote on the budget bill. Smith sponsored the 2018 reauthorization of PEPFAR and led the charge this year to implement stronger abortion restrictions on the program.

Smith quoted a recent Washington Times op-ed from former House Speaker Newt Gingrich, a Republican, who argued “the Biden administration has hijacked one of President George W. Bush’s greatest accomplishments… to promote abortion on demand in the developing world.”

Staunchly anti-abortion, Bush himself called for Congress to “reauthorize PEPFAR for another five years without delay” and dismissed concerns about organizations funded by the program also providing abortions. 

“We are on the verge of ending the HIV/AIDS epidemic. To abandon our commitment now would forfeit two decades of unimaginable progress and raise further questions about the worth of America’s word,” Bush wrote in a Washington Post op-ed last month. “The reauthorization is stalled because of questions about whether PEPFAR’s implementation under the current administration is sufficiently pro-life. But there is no program more pro-life than one that has saved more than 25 million lives.”

PEPFAR’s annual budget of roughly $7 billion is less than one-tenth of 1% of the federal budget, Bush noted.

“It has always been bipartisan. I worked with President Bush. We made some agreements that would continue to be bipartisan,” said Rep. Barbara Lee, a left-wing Democrat who was no friend of Bush’s, but worked with his administration to help author the legislation that became PEPFAR. “Those now that are trying to undermine it are really putting the program and lives in danger.”

In 2022, PEPFAR provided treatment to over 20 million people living with HIV across the globe, funded testing services for nearly 65 million people, and enrolled 1.5 million clients on antiretroviral pre-exposure prophylaxis, known as PrEP, which helps prevent HIV infection.

Since its implementation in 2003, PEPFAR has supplied medication that helped 5.5 million children be born without contracting HIV/AIDS from their mothers and provided funds to help care for seven million orphans, vulnerable children and caregivers.

AIDS has killed over 40 million people since 1981. There is a death related to AIDS every minute, according to the United Nations. And of the roughly 40 million people living with HIV today, the World Health Organizations estimates nearly 70% live in Africa, where PEPFAR is heavily focused.

“PEPFAR stands out as the most significant contribution made by any single country to the global effort to end AIDS,” said Winnie Byanyima, an Ugandan diplomat who lost family to the virus and who now serves as the executive director of the Joint United Nations Programme on HIV and AIDS, at a U.N. event last month. “The world needs PEPFAR to be reauthorized to finish the job of ending AIDS.”