PEPFAR in Peril: The Far-Right Wants to End the Lifesaving Global HIV Program

It felt like a scene out of the 1980s or ’90s — activists protesting for HIV resources and staging a sit-in as camera bulbs flash. This time though, the September protest was in the Washington, D.C., office of then-House Speaker Kevin McCarthy, with advocates demanding the reauthorization of a program to fight HIV and AIDS in the U.S. and sub-Saharan Africa; seven people were arrested.

Demonstrators from Housing Works and Health GAP chanted “Pass PEPFAR now, McCarthy!,” referring to the President’s Emergency Plan for AIDS Relief, which started in 2003 under President George W. Bush.

PEPFAR, which is estimated to have saved 25 million lives through distribution of anti-HIV drugs, educational programs, and more, expired September 30. Congress passed a spending deal that same day that kept the government running for a month and a half, but it did not include PEPFAR. If nothing changes, “organizations that deliver lifesaving drug treatments and other forms of support to H.I.V. patients could have to curtail their work. And some specific measures could lose funding, including one that provides care for orphans and other vulnerable children,” The New York Times reported in early October.

PEPFAR’s reauthorization is being held up by Republicans in the U.S. House of Representatives, who claim that some PEPFAR funds are being used to promote abortion. A report released this year by the Heritage Foundation, a right-wing think tank, asserted that “the Biden Administration has misused the program as a well-funded vehicle to promote its domestic radical social agenda overseas.”

U.S. Rep. Chris Smith of New Jersey has been part of the Republican group holding PEPFAR funds hostage. (Larry French/Getty Images)

Biden’s so-called agenda includes LGBTQ+ rights and access to abortion, the think tank and other conservatives claim. The report also calls HIV and AIDS “primarily a lifestyle disease” that “should be suppressed though education, moral suasion, and legal sanctions.” Republican U.S. Rep. Chris Smith of New Jersey has highlighted the Heritage Foundation report in the fight over PEPFAR. President Biden’s administration and the activists who protested at McCarthy’s office say the allegation about abortion is baseless.

However, anti-abortion groups want to put language into the PEPFAR reauthorization that explicitly prohibits any funds from paying for abortions, and they want reauthorizations annually, not every five years, as has been the case. “They also argue that the shorter extension buys time in the event a Republican returns to the White House in 2025, potentially ushering in changes to PEPFAR and the United States’ broader global health strategy,” The Washington Post reported in July.

The Biden administration contends that annual reauthorization will weaken the program, and it wants a five-year reauthorization with no new conditions added. The protesters say House Republicans reneged on supporting a five-year reauthorization.

First Lady Jill Biden (far right) speaks with South African participants of two different programs funded through PEPFAR. (Tara Mette/Getty Images)

“PEPFAR has saved millions of lives. It is criminal for some members of Congress to treat it as a political football,” Housing Works CEO Charles King, who was arrested in September, said in a press release. “AIDS isn’t over until it’s over for everyone. PEPFAR has been essential to helping people in developing countries flatten the curve of HIV transmission. The United States has committed to the international goal of ending AIDS by 2030, and we cannot do that if PEPFAR is threatened.”

“Haiti relies on PEPFAR funding for all of its HIV treatment,” King continued. “Housing Works is intimately involved in monitoring the distribution of [antiretroviral drugs] in Haiti, which are 100 percent funded through PEPFAR, so we are acutely aware of the risk posed by any threat to the funding of this vital program.”

“House Republicans are playing political games with the lives of countless adults, children, and newborns with HIV and most affected by HIV across the globe and here in the U.S.,” added Asia Russell, executive director of Health GAP, who was also arrested Monday. “Extremists in the House have sunk to a new low. Never in the 20-year history of PEPFAR have lawmakers pulled such outrageous stunts. We demand a five-year reauthorization of PEPFAR in its current form, and full funding for HIV treatment and prevention programs in the U.S.” A House subcommittee has recommended cutting $767 million from the fiscal 2024 budget for domestic HIV programs.

A man administers an HIV test to a Ugandan youth in 2017. (Shutterstock)

Five others were arrested along with King and Russell. All seven were charged with unlawful entry, Capitol Police told The Hill.

“From the beginning of the epidemic, HIV has disproportionately affected Black and Brown communities, especially gay and bisexual men, transgender people, and women who engage in sex work or have other risk factors,” the Housing Works/Health GAP press release concludes. “These budget cuts would not only bring efforts to end the epidemic to a halt, but they would lead to setbacks in places where we have been making significant progress.”

Activists demand the reauthorization of PEPFAR during a September protest at Rep. Kevin McCarthy’s office. (Health GAP)