Guest Opinion: Let's reauthorize PEPFAR

  • by Barbara Lee
  • Wednesday March 1, 2023
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Congressmember Barbara Lee waves to the crowd at the kickoff for her U.S. Senate campaign February 25 at Laney College in Oakland. Photo: Jane Philomen Cleland
Congressmember Barbara Lee waves to the crowd at the kickoff for her U.S. Senate campaign February 25 at Laney College in Oakland. Photo: Jane Philomen Cleland

During President Joe Biden's recent State of the Union address, he briefly touched on a program that I helped start that has benefited people living with HIV/AIDS in countries around the world — the President's Emergency Plan for AIDS Relief, or PEPFAR.

The president's mention of PEPFAR touted the success of the global health initiative that just reached its 20th birthday. As I reflected on Biden's remarks, I remembered those we have lost in the struggle against this disease, and stand in solidarity with the millions across the globe who continue to fight against it. PEPFAR was announced during President George W. Bush's State of the Union speech 20 years prior, in 2003, but was born well before that.

In the early 2000s, I met Bush, a man whose policy I rarely agreed with over the years, including our largest disagreement over engaging in the wars in Iraq and Afghanistan. Despite our policy differences, Bush and I did connect on the shared goal of tackling the HIV/AIDS crisis.

I had been working on this issue for decades. Upon the retirement in 1997 of the late, beloved Congressmember Ron Dellums (D-Oakland), who was a champion of global health initiatives and so many other issues of equity and justice on the global scale, I won his congressional seat. In 1999, I introduced legislation to create an "AIDS Marshall Plan for Africa" with his input and, in 2001, I brought this issue up to Bush in the Oval Office.

He asked about the beaded red ribbon I wore to the White House that day. I explained to him what was taking place in Africa and the disproportionate impact this deadly disease was having in the Black community in the United States.

Along with the Congressional Black Caucus, I worked with Bush and others in Congress — both Republicans and Democrats — to craft a global HIV/AIDS legislative package. We wrote to him in 2002, urging him to draw his attention to the crisis, saying "we cannot win the war against AIDS without greater financial resources and a clear plan of action for the United States." He pledged the investment at his State of the Union Address, and in May 2003, we passed H.R. 1298, the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act. That legislation established what we now know as PEPFAR. Since then, because of bipartisan, bicameral efforts in Congress, PEPFAR has provided billions of dollars to address the HIV and AIDS pandemic.

This year is the 20th anniversary of PEPFAR and because of it, we've seen incredible progress towards our goal of an AIDS-free generation. But as we prepare to celebrate this milestone, we must not allow history to be misrepresented.

It was years of hard work on both sides of the aisle, from lawmakers, activists, and advocates alike that got us to where we are today. I was proud to have been at the bill signing by Bush, which was the culmination of tough negotiations between Democrats and Republicans. Notably there was a Republican president, Democrats were in the minority in both chambers, and the bill passed the House with the votes of 205 Democrats and 230 Republicans.

People like Bush and former Senator Bill Frist (R-Tennessee) were noble partners in this effort and deserve staunch praise for their work to make this progress, as well as the staff who continue to work tirelessly behind the scenes. The efforts of warriors like the late, great Congressmember Donald Payne Sr. (D-New Jersey), former Senator John Kerry (D-Massachusetts), former House Speaker Nancy Pelosi (D-San Francisco), and artists and activists like Bono cannot be forgotten either.

However, let's make one thing clear: the creation of PEPFAR and the Global Fund would not have happened without the work of the Congressional Black Caucus and the sacrifice of countless Black HIV/AIDS activists who made extreme sacrifices for the progress we see today. There was no "white savior" in this fight, as the imagery so frequently seen of African children being cared for by white volunteers would suggest.

Systemic racism plays out in many different ways, but among the most harmful is the whitewashing of our history. As we witness the efforts to take the history of the U.S. government's legal institution of slavery out of American history books today, we risk — yet again — seeing the denial of the stories of Black leadership in this and countless other social and political movements.

In the fight for our freedom, courageous warriors like Leonard Grimes and Sarah Parker Redmond are disregarded as abolitionists, while William Lloyd Garrison and John Brown are crowned as heroes of the movement.

In the fight for women's rights and suffrage, Mary Church Terrell and Ida B. Wells take a backseat to the praise of Susan B. Anthony and Elizabeth Stanton.

And in the fight for reproductive freedom, the late Congressmember Shirley Chisholm (D-New York) and Byllye Avery are overlooked compared to the heroic work of Emma Goldman and Margaret Sanger.

As we begin strategizing the work we will continue to do as we approach the 20th anniversary of PEPFAR, I cannot help but think of the sacrifices made by so many over the last two decades to see the progress we're seeing now. Globally, AIDS-related deaths have been cut by almost two-thirds, and new HIV infections have been reduced by more than half since their respective peaks. But as we saw in the COVID pandemic, there were major setbacks. Success is not inevitable; more work still needs to be done.

It's time for us to reauthorize PEPFAR and continue its mission of saving lives and eradicating the disease. Biden mentioned PEPFAR as a success story, seeking to model after it programs to fight cancer. As much as PEPFAR should be applauded and used as a guiding light for other public health programs, its mission has not yet been completed. Until we have reached an AIDS-free generation, PEPFAR will continue to be critical in our fight against the disease.

In the same way it would be a grave mistake to try and rewrite the history of the fight against HIV/AIDS by excluding the efforts of the African American community, including the Congressional Black Caucus, it would be a mistake to rest on our laurels and not reauthorize PEPFAR. The best way to celebrate its success is by honoring it with more investment.

We must continue fighting with the global community, including Africa and the African Diaspora, as well as our broad coalition of partners to ensure an AIDS-free generation is achieved by 2030.

Congressmember Barbara Lee (D-Oakland) is a straight ally and a founder of the Congressional Equality Caucus. On February 21 she formally announced that she is running in the primary for the U.S. Senate seat being vacated by Senator Dianne Feinstein (D-California). This piece is adapted from an essay she wrote on Medium last December.

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