The United States President’s Emergency Program for AIDS Relief, signed into law in 2003 by President George W. Bush, is at risk of funding restrictions when it goes before Congress this month. PEPFAR has been credited with saving over 25 million lives globally and provides crucial HIV/AIDS prevention, education and treatment services. Socioeconomic progress in low-income countries affected by HIV/AIDS is under threat if PEFAR is restricted. PEPFAR also targets tuberculosis and malaria, and funding restrictions could allow these diseases to gain a foothold.
The partisan attack on PEPFAR, and specifically pro-life arguments, have intensified recently. Tim Meisburger from the Heritage Foundation advocates for reform, with concerns that PEPFAR has transitioned from an emergency response to a development program, expenses associated with international NGOs and contractors are excessive and lack of sustainability by the countries receiving PEPFAR foreign-aid. Meisburger highlights concerns over the diversion of foreign aid from other life-threatening conditions like diarrheal diseases, which claim more lives in Africa than HIV/AIDS.
The contentious issue of women’s reproductive healthcare and abortion further complicates PEPFAR’s funding prospects. While PEPFAR does not support abortion, the association with other organizations that provide abortion services fuels opposition. The debate is rooted in politics, with accusations of cultural imperialism and neocolonialism. Some lawmakers have attempted to reshape PEPFAR based on their social and cultural positions, adding to the polarization.
Project HOPE is a global humanitarian organization that responds to many healthcare needs. Ending these diseases is high on its list of priorities. Dr. Uche Ralph-Opara, a physician, and Project HOPE’s deputy chief health officer, met me this summer in Washington, D.C., in my role as the chief medical correspondent for MSNBC’s Morning Joe. We spoke inside Project HOPE’s headquarters to get out of the hot summer sun blazing down onto the Capitol.
“My very first goal at public health programming,” Ralph-Opara said, “was working on PEPFAR-funded HIV care and treatment programs in Nigeria.” She still prefers to be called Uche, a habit started 18 years ago, when she entered the global health space, to make her young patients and their mothers comfortable.
Stigma associated with HIV/AIDS, gender and sexual orientation continues to loom large in efforts to manage the pandemic. Poor treatment adherence and therapy cessation pose a serious threat to the ongoing success of PEPFAR, as do any impediments to congressional reauthorization.
“I think we are making good progress towards achieving the goals of ending HIV/AIDS as a public health threat by the year 2023,” Dr. John Nkengasong, told me in a recent interview. He is the senior bureau official at the Bureau of Global Health Security and Diplomacy within the U.S. State Department and plays a pivotal role in the United States global AIDS response. He and Ralph-Opara know that PEPFAR plays a critical role in the lives of millions of marginalized individuals worldwide.
PEPFAR has achieved remarkable progress over its 20 years of existence, including increased access to antiretroviral medication, reduced mortality, fewer babies born with HIV and expanded prevention and education services. In Sub-Saharan Africa, where two-thirds of the world’s HIV/AIDS cases were located 25 years ago, PEPFAR’s initiatives have made a significant impact. HIV infections have declined by over 50 percent and AIDS-related deaths by two-thirds during the program’s two decades.
“PEPFAR speaks for itself with an unprecedented megaphone,” Dr. Anthony Fauci told me in a recent interview. “This is the most impactful public health program that has ever been initiated by the United States in the history of public health.” In its 20 years, it’s reached more than 50 countries and saved, directly or indirectly, more than 25 million lives, he pointed out, adding that his plea to Congress is simple: “look at the history of PEPFAR,” which, he added, “was authorized by one of the most beautiful bipartisan agreements between Republicans and Democrats.”
According to Dr. Fauci, there is a paradox. “If your fundamental core is the right to life,” he told me, “and preserving the life of people and children, unborn children, look at the unborn children who will, now, if you do not reauthorize PEPFAR, die by the tens and hundreds of thousands.”
“And remember that the programs are not directly funding abortion,” he added. “They are funding through organizations that have family planning, which is critical to the health of these nations, as part of their program.”
Congress will soon debate PEPFAR’s future. Kaiser Family Foundation reports that the foreign aid program has some components permanently authorized, while others will expire at the end of Fiscal Year 2023, which ends September 30. It is crucial to recognize this is not a political program. Protecting the lives and health of those at risk of HIV/AIDS, tuberculosis and malaria is a moral imperative regardless of political views. A moral dilemma exists between saving the lives of the unborn and the death-sentence of untreated HIV.
Lawrence Gostin, a global health law expert at Georgetown University who I interviewed years ago, emphasizes the need for the Biden administration to advocate for PEPFAR’s funding. Biden and White House chief of staff Jeff Zients, he told Politico, need “to get on the phone and twist some arms.”
Physicians know the value of positivity and optimism in health. Ralph-Opara believes the goal of ending HIV/AIDs as a public health threat by 2030 is realistic. “But a lot of work must be done,” she said. “A lot of efforts must be put into continuing to support the countries towards sustainability.
“We want to see a situation where by 2030, we have less than 200 new HIV infections,” she added. “We are currently at 1.5 million, so you see, we have a long way to go.”