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The successful anti-AIDS program PEPFAR is under threat in Congress


Abortion politics have drawn in one of the most celebrated foreign aid efforts in U.S. history, a multibillion-dollar program called the President's Emergency Plan for Aids Relief, or PEPFAR, for short. Over the last two decades, it's reported saving 25 million lives across the globe and enjoyed broad bipartisan support. To tell us why that could be changing. Here's NPR global health correspondent Nurith Aizenman. Now, Nurith, all right, so tell us, first off, a bit more about why PEPFAR is considered so important.

NURITH AIZENMAN, BYLINE: Yeah. So it helps to recall just how dire things looked back when PEPFAR was first started by President George W. Bush in 2003. Outside of wealthy countries, AIDS drugs were basically out of reach. In Africa, AIDS deaths were at their peak, almost 3 million people dying every year. So PEPFAR galvanized U.S. funding for prevention and treatments, $110 billion over the last two decades, and with support from pretty much every quarter in the U.S. - Democrats, Republicans, evangelicals, global health aid groups, it's been the rare U.S. government program that everybody seemed to love.

MARTÍNEZ: All right. Everyone seemed to love it. What's changed?

AIZENMAN: Anti-abortion groups want to bar PEPFAR from partnering with any foreign aid groups that, with their own non-U.S. money, lobby for abortion rights or provide abortions, referrals or information about it. In fact, President Donald Trump did this through executive action when he was president. But President Biden rescinded the policy as soon as he came into office. And late last week, House Republicans tried to put that policy into law through language included in a larger foreign operations spending bill that they adopted. And that's essentially teed up a fight with the Democratic-controlled Senate, where it's seen as a nonstarter.

MARTÍNEZ: What are their arguments?

AIZENMAN: Well, supporters of PEPFAR in its current form say there are just a limited number of on-the-ground aid groups that PEPFAR can partner with. So while Trump's policy only lasted a few years, forcing PEPFAR to terminate those partnerships over the long haul would eventually really impede its effectiveness. In fact, that appears to be the reason that back when George W. Bush was president, he made a point of not imposing those requirements on PEPFAR, even as he applied them to some other foreign aid funding. Also, U.S. law already prohibits any of the foreign partners from using their U.S. PEPFAR funding to provide abortions.

MARTÍNEZ: All right. So what's the argument by anti-abortion advocates?

AIZENMAN: Well, I put that to one of them, Arielle Del Turco of the Family Research Council. And here's what she had to say about these foreign partners. They're called nongovernmental groups, or NGOs.

ARIELLE DEL TURCO: Money is fungible. So when the U.S. government, through PEPFAR, is giving money to these pro-abortion NGOs abroad, we're allowing them to use other money that they already have in their bucket to perform abortions and to promote abortions.

AIZENMAN: And, you know, worth noting that as a result of this controversy, the so-called authorizing legislation that puts certain rules on PEPFAR's operations every five years has just lapsed.

MARTÍNEZ: So how great of - is the risk to PEPFAR?

AIZENMAN: Well, I spoke to Jen Kates of the Kaiser Family Foundation. She says the program remains very popular in Congress, so she's not expecting funding cuts. But given how seemingly bulletproof PEPFAR has been, just the fact that it's even temporarily caught up in an abortion fight...

JENNIFER KATES: It sends a potentially, you know, sad message to America and to the world that we can't move forward with things that really work and that really are about saving lives.

AIZENMAN: Longer term, Kates does worry about an erosion in support for PEPFAR's funding.

MARTÍNEZ: That's NPR's Nurith Aizenman. Nurith, thanks.

AIZENMAN: You're welcome.


NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

A Martínez is one of the hosts of Morning Edition and Up First. He came to NPR in 2021 and is based out of NPR West.
Nurith Aizenman
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