Congress’s posturing on HIV funding threatens 20 years of progress

“Several thousand people dying a day is not a cause, it’s an emergency,” U2 frontman Bono said after a contentious meeting with President George W. Bush back in 2003. Bono had persuaded President Bush to allocate billions to distribute HIV medications throughout Africa. But it wasn’t enough; Bono knew the crisis demanded more from the U.S.

Two years later Bono recalled, “People openly laughed in my face when I suggested that this administration would distribute antiretroviral drugs to Africa. … There’s 200,000 Africans now who owe their lives to America.”

Today that number has grown to over 25 million. In total, the President’s Emergency Plan For AIDS Relief (PEPFAR) has spent more than $100 billion in HIV/AIDS relief and has become what the Institute for Peace calls President Bush’s “landmark global health initiative.” 

This year marks its 20th anniversary — and it’s in jeopardy due to a bitter partisan battle over one of the nation’s most divisive political issues: abortion.

It’s hard to overstate the sheer scale of PEPFAR’s reach and impact. Thanks in large part to funding provided by the U.S., more than 5 million babies have been born HIV-free. Nearly 65 million people have received testing services. More than 20 million are currently receiving antiretroviral therapies. And 30 million voluntary male circumcisions have been medically performed to help prevent HIV infection.

PEPFAR is considered the largest program by any nation to address a specific disease in history. It has helped prevent HIV infections and contain the spread of the virus in more than 50 countries across the world. And it has increased child immunizations and reduced maternal and child mortality in those areas as well.

Since PEPFAR’s inception, Congress has reauthorized funding for the program every five years with strong bipartisan support. But a key vote to renew funding for the next five-year cycle failed to meet a Sept. 30 deadline. 

A group of GOP lawmakers claim PEPFAR funding is being routed to organizations that provide abortion services, which the White House denies. The GOP-controlled U.S. House passed a one-year reauthorization for PEPFAR with specific abortion restriction provisions, but its fate in the U.S. Senate is now in doubt.

Existing resources can keep the program going until September 2024, but Congress’s failure to support PEPFAR’s upcoming five-year cycle is symbolically significant. 

U.S. Department of State spokesperson Matthew Miller put it this way: “[It] sends a message to partners around the world, especially in Africa, that we are backing down from our leadership in ending HIV/AIDS as a public health threat.”

Funding debates over spending measures happen all the time in Washington. But Congress’s willingness to let politics block a continuing long-term commitment of a two-decade-long program — and allow the fate of millions around the world to be put in jeopardy — marks an astonishing new low.

PEPFAR began because an international celebrity and a conservative U.S. president put their views of one another aside and realized they could have a monumental impact and achieve a tremendous amount of good if they worked together. That unlikely alliance of two very different individuals, with different backgrounds and different constituencies, resulted in millions of people across the globe living longer lives.  

And for 20 years PEPFAR’s history of widespread bipartisan agreement in Congress followed their example. Continued support from Congress to reauthorize PEPFAR gave us hope that Washington, no matter how polarized, could still unite on the important issues. The ones that really matter. Ones that can have a lasting legacy on the world.

Now that, too, is being tested. PEPFAR clarifies in its own governing documents that it “does not fund abortions, consistent with longstanding legal restrictions on the use of foreign assistance funding related to abortion.” Yet some GOP lawmakers have undermined the strength of PEPFAR by demanding stricter assurances despite a lack of evidence that PEPFAR has funded abortion or supported any of the activities PEPFAR expressly prohibits.

“[T]his is really just a political debate, an ideological debate about abortion,” says Kaiser Family Foundation’s Jen Kates.

And that’s shameful. As lawmakers return to their districts this holiday season, Congress should remind itself how PEPFAR started, the millions it has saved, the millions more who stand to benefit — and that it’s not a sign of weakness to work together to advance the greater cause of our own humanity.

Lyndon Haviland, DrPH, MPH, is a distinguished scholar at the CUNY School of Public Health and Health Policy.