Lifesaving HIV/AIDS program's future uncertain amid stop-and-start foreign aid pause

WASHINGTON (OSV News) -- The future of PEPFAR, the U.S. government's global effort to combat HIV/AIDS, has been called into question amid a broader pause on foreign assistance and allegations from some Republican lawmakers that the Biden administration improperly allowed some of its funding to be spent on abortions.

PEPFAR, the U.S. President's Emergency Plan for AIDS Relief, authorized by Congress and President George W. Bush in 2003, is the largest global health program devoted to a single disease. It is credited with saving 25 million lives and with scaling back the epidemic's spread.

The U.S. Agency for International Development notes PEPFAR funds "cannot be used to lobby for or against abortion, consistent with longstanding legal restrictions on the use of U.S. foreign assistance funding for abortion related activities."

As such, several Catholic organizations including Catholic Relief Services have in the course of the program's history backed its lifesaving efforts.

An executive order from President Donald Trump issued on his first day of his second term halted virtually all U.S. foreign assistance. Amid that pause, his administration halted funding for PEPFAR. Some of the program's recipients were reportedly issued guidance to halt the distribution of lifesaving medicine, even though they had it on hand. But Secretary of State Marco Rubio issued a waiver Jan. 28 for lifesaving humanitarian assistance, which the State Department said included PEPFAR.

But PEPFAR's future was called into question prior to Trump's order, and its reauthorization may become the subject of debate in the coming months. Congress broke from previous precedent to reauthorize the program for just one year in 2024, rather than five years as was typical, amid concerns from some pro-life advocates about the potential for some funding being diverted to groups that provide or promote abortion. Others argued safeguards are in place to prevent such spending.

However, PEPFAR came under renewed fire recently from some congressional Republicans who argued the Biden administration improperly allowed the program to fund abortions. A compliance check revealed some nurses at a recipient entity in Mozambique performed 21 abortions against the terms of the program. Abortion is legal in that country, but its government refunded the money -- $4,100 -- after the issue came to light as it violated the terms of the PEPFAR program, Politico reported.

Sen. Jim Risch, R-Idaho, chair of the Foreign Relations Committee said earlier in January that PEPFAR "is certainly in jeopardy."

In a Jan. 23 interview with OSV News, Rep. Chris Smith, R-N.J., a longtime supporter of PEPFAR, said there was a need to add language prohibiting administrators from funding groups that advocate for abortion access.

"I think we need a top-to-bottom review of PEPFAR," Smith, who is Catholic, said. "What have we been funding? What are we doing with this money?"

Asked if he views PEPFAR as in jeopardy, Smith replied, "I think it needs to be seriously evaluated" in order to ensure it fulfills its stated mission of fighting HIV/AIDS in line with both the letter and spirit of the law.

"We need to get back to first things on that," Smith said. He called for "a very aggressive reevaluation of PEPFAR," to ensure its funds are not improperly used.

Amid the previous reauthorization debate, a July 2023 letter from Catholic Relief Services and the U.S. Conference of Catholic Bishops to congressional lawmakers argued in favor of PEPFAR's reauthorization while outlining important principles to guide Congress.

"We write to affirm PEPFAR's extraordinary life-saving work to date, and to express our strong, ongoing support for its goals and hope for its robust continuation," the letter said.

David J. Kramer, executive director of the George W. Bush Institute, celebrated the waiver Rubio issued for PEPFAR in a Jan. 29 statement.

"The Bush Institute welcomes Secretary of State Rubio's issuance of an emergency humanitarian waiver for life-saving aid programs around the world, including PEPFAR, following the earlier freeze on funding for previously approved foreign assistance programs," he said. "This action will save lives and uphold America's reputation as a compassionate nation."

Data from the federal government shows PEPFAR is supporting life-saving antiretroviral therapy for 20.6 million people. This includes 566,000 children with HIV in 55 countries as of Sept. 30, 2024.