Editorial: Congress must reauthorize PEPFAR

  • by BAR Editorial Board
  • Wednesday August 2, 2023
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PEPFAR, which marks its 20th anniversary, is up for reauthorization this year. Image: Courtesy U.S. State Department
PEPFAR, which marks its 20th anniversary, is up for reauthorization this year. Image: Courtesy U.S. State Department

It is critical that Congress reauthorize the President's Emergency Plan for AIDS Relief, better known as PEPFAR. Congressmember Barbara Lee (D-Oakland) wrote a Guest Opinion piece on that topic for the Bay Area Reporter in March, but since then, the legislation faces the new threat of abortion politics that could derail what has been seen as a successful program to curb HIV transmissions and AIDS cases around the world.

Truly, this is the one thing that President George W. Bush got right when he established PEPFAR 20 years ago with the help of Lee, the Congressional Black Caucus, and lawmakers on both sides of the aisle. The bipartisan support is a hallmark of PEPFAR that has — so far — withstood the polarization of politics.

Yet, today, reauthorization of PEPFAR is in doubt. A Washington Post article details that it "has been abruptly bogged down in a domestic political fight, with Republicans citing allegations that the program's funding is being used to indirectly support abortions — claims that health advocates, Democrats and PEPFAR officials say are baseless."

The paper goes on to report that lawmakers have spent months arguing about whether PEPFAR should be reauthorized for five years, one year, or not at all. "If PEPFAR doesn't get reauthorized, the program can continue — but it could send some pretty chilling messages to people in the field who depend on PEPFAR for life support," said Jennifer Kates, director of global health and HIV policy at KFF, a health policy organization that has tracked the provisions set to expire September 30, according to the Post article.

The Kaiser Family Foundation pointed out that there are some requirements that are time-bound and would sunset if a reauthorization bill is not passed, or Congress could extend them through another legislative vehicle. The Biden administration is pursuing a five-year "clean" reauthorization and does not prefer the one-year renewal that some Republicans have suggested.

Shannon Kellman, a co-chair of the Global AIDS Policy Partnership and senior policy director at Friends of the Global Fight, said that PEPFAR is crucial and has been credited with saving more than 25 million lives. "It has long-standing bipartisan support," Kellman said during a Zoom call with the B.A.R., adding that the program provides treatment and access to medicine. She confirmed that if PEPFAR is not reauthorized, "the funding won't stop but Congress will lose oversight."

And, she noted, "We risk the role the U.S. plays in fighting not just HIV but other diseases. PEPFAR is probably the best known program in Africa funded by the U.S."

One thing that would be lost if PEPFAR is not reauthorized is what's known as the global match. Kellman explained that the PEPFAR law also authorizes the Global Fund to Fight AIDS, Tuberculosis, and Malaria. The global match requires that for every $1 the U.S. contributes to the Global Fund, $2 must come from other donors, such as other governments or entities. This has proved to engage and maintain support for fighting infectious diseases and demonstrates that the U.S. is not funding more than its fair share, Kellman said. Countries contribute funds so they have a seat at the table. "That match requirement would disappear without reauthorization," she said. All told, eight clauses sunset on September 30 without reauthorization.

As the deadline draws near, it's worth noting that PEPFAR spans more than 50 countries, according to the Kaiser Family Foundation. Fiscal Year 2023 spending was $7.5 billion, with approximately $5.5 billion for bilateral HIV efforts and $2 billion for U.S. contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Kellman and her colleagues at GAPP and its partner organizations are reaching out to lawmakers. "PEPFAR has always been a coalition of strange bedfellows," she said, quoting Dr. Mark Dybul, a gay man who's the former executive director of the Global Fund. Organizations on the far left and far right, including faith-based groups, support the program.

It's unsurprising that some fringe Republicans in Congress are trying to tie abortion to an HIV/AIDS program — they will seek any opportunity, however unrelated and unfounded, to cut spending on successful health programs like PEPFAR. The accusation that PEPFAR was being used to "prop up" abortion providers first surfaced in a conservative Heritage Foundation report () in May, according to the Post. Heritage accuses the Biden administration of using PEPFAR as a "well-funded vehicle to promote its domestic radical social agenda overseas, as it has done with other foreign aid programs."

We haven't seen evidence of this, but radical conservatives don't rely on facts, as we see time and time again on numerous issues, especially those that help people of color and other vulnerable groups, such as those living with HIV/AIDS or at high risk for the disease. Not all Republican lawmakers are opposed to PEPFAR or buy into this latest version of alternative facts.

Kellman is hopeful that in the end, there will remain broad bipartisan support for the program and it will be reauthorized, ideally for the full five years. PEPFAR is one program that the U.S. does right, and members of Congress should see it for what it actually does — help prevent and treat HIV/AIDS — and not what some right-wing foundation has drummed up without evidence.

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