The PEPFAR Controversy

This may have flown under the radar a little bit, but on Monday, September 11, seven AIDS activists were arrested after “swarming” House Speaker Kevin McCarthy’s office to protest the delay in renewing PEPFAR, the U.S. President’s Emergency Plan for AIDS Relief. PEPFAR was signed into law by President George W. Bush 20 years ago.

Per the U.S. government’s Department of State website, “Through PEPFAR, the U.S. government has invested over $100 billion in the global HIV/AIDS response, the largest commitment by any nation to address a single disease in history, saving 25 million lives, preventing millions of HIV infections, and accelerating progress toward controlling the global HIV/AIDS pandemic in more than 50 countries.”

In other words, PEPFAR is devoted to funding the distribution of antiretroviral drugs in mostly underserved countries, both for people “living with HIV” in these countries and, presumably, for people not yet living with HIV in the form of PrEP. (One could be forgiven for wondering if this is a massive money laundering scheme on the part of the government and big business to line the pockets of pharmaceutical companies.)

Since PEPFAR was signed into law by President Bush the younger, it has come up for renewal every five years, and until this year, it passed through renewal fairly easily. So what happened to delay its approval this year, and why did the activists storm McCarthy’s office? According to an article from September 12, 2023, in The Advocate:

PEPFAR, which is estimated to have saved 25 million lives through distribution of anti-HIV drugs, educational programs, and more, expires September 30. Its 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.”

(Notice the language used here. Like “HIV, the virus that causes AIDS,” the phrase “PEPFAR has saved 25 million lives” has to be repeated every time the acronym “PEPFAR” is mentioned just in case we forget. Also, how did they come up with the “25 million” estimate?)

No, the reason Republicans in the House of Representatives want to delay PEPFAR’s reapproval actually has nothing to do with HIV or AIDS at all, but it is that these Republicans believe that the PEPFAR program is being used to “promote abortion” overseas and “promote a radical gender ideology.” From an opinion piece on MSNBC in July by Hayes Brown, Republicans want to kneecap the GOP’s greatest modern legacy (the GOP is in serious trouble if this is their “greatest modern legacy”—I digress):

On the heels of that [Heritage Foundation] report, conservative groups sent a letter to GOP lawmakers claiming that PEPFAR funds are “used by nongovernmental organizations that promote abortions and push a radical gender ideology abroad,” according to Devex, a website covering global development. The roughly $5 billion a year in funding that the program receives is “being used as a massive slush fund for abortion and LGBT advocacy,” Family Research Council’s vice president for policy and government affairs, Travis Weber, recently told Christianity Today.

Neither the letter nor the Heritage Foundation report actually offer up any proof that this is happening. Instead, they highlight that the International Planned Parenthood Federation receives USAID funding as part of a project to “promote and sustain improved health and agency.” They also interpreted language in a recent PEPFAR strategy document about “sexual health and reproductive rights” as being secret code for abortions. As Christianity Today reported, a newly added footnote in the document clarifies that the “reproductive health” only refers to “HIV prevention, testing, and treatment services,” “education, testing and treatment for sexually transmitted infections,” cancer screening and treatment, and “gender-based violence prevention and care.”

I have no desire to debate abortion here; all I will say is that, in my opinion, abortion and abortion rights are more nuanced than most people on either side of the issue are willing to admit. The more important issue is the concept of PEPFAR itself. I am less concerned about its use to allegedly “fund abortions overseas” than I am about the fact that this is clearly being used to promote PrEP and ARVs for largely Black, Hispanic and Asian countries. Recall the recent hand-wringing over the “poor uptake” of PrEP among Black Americans. You can find the full list of “PEPFAR-supported countries and regions” at this Department of State link.

Of course, all the usual suspects are very upset about this delay, including Dr. Fauci, interviewed for The Advocate in a piece from August 2023, GOP Declares War on HIV Program as Dr. Fauci Rings Alarm. (I love the fawning tone here.)

You might assume that Dr. Anthony Fauci, after 54 years working at the National Institutes of Health and helping save countless lives, has retired so he can rest. However, Dr. Fauci doesn’t have time to retire.

[…]

PEPFAR is the U.S. President’s Emergency Plan for AIDS Relief, which was signed into law 20 years ago this summer by President George W. Bush. It serves as a conduit to providing HIV medications to individuals in impoverished nations who would otherwise lack access to these drugs.

When I spoke to Fauci a couple years ago years ago on the 40th anniversary of the discovery of HIV, he cited the opportunity to be the architect of the program as one of his greatest achievements. "It is the largest commitment by any nation to address a single disease in history," he told me. "It's been an honor to help lead this. I really value my participation in this program that has already saved 15-18 million (in 2021) lives around the world."

[…]

However, groundless claims from anti-abortion activists have put the program in jeopardy.

[…]

As a result, Republicans in Congress are threatening not to reauthorize the program.

“The idea that this program would be interrupted, despite its overwhelming success, is unfortunate,” Fauci said. “There’s a real danger to associate the program with cultural issues as opposed to scientific ones that clearly show PEPFAR is saving lives.”

“it seems paradoxical that abortion rights groups who fight for life want to interfere with a program that has saved millions of lives,” Fauci pointed out. “If the program doesn’t function, lives aren’t saved, millions of them.”

Instead of castigating the program, shouldn't these groups, as well as all Americans, be celebrating the 20^th anniversary of this milestone? “What’s ironic is that it was signed into law by a conservative Republican President, and it is without question George W. Bush’s greatest achievement. It took years to put together, in a bipartisan way, and it is one of the world’s signature global health initiatives. The thought of it not being authorized is not only dangerous, but disastrous.”

My instinct is to automatically be suspicious of anything endorsed by Dr. Fauci, but the problem is truly much bigger than it seems. PEPFAR is an HUGE program, and enormous amounts of taxpayer money are spent on it every year, and for what purpose? So that we, “enlightened Westerners,” can swoop into poor Black, Hispanic, and other countries to give them a lifetime of toxic medications whose adverse effects are well known? Or is it really just a money laundering scheme to line the pockets of Big Pharma using racist tactics?

What do you think about PEPFAR and the delay in reauthorizing it? Do you think it will eventually pass? (Spoiler: It almost certainly will.)

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