Here in Washington, D.C., I often feel like moral, bipartisan leadership in politics is on life support. This week, news headlines detailed the ongoing saga of a speakerless House amid an escalating crisis in the Middle East and another potential government shutdown. But beneath the headlines, there are other costs of our ongoing political dysfunction, including a story I think deserves more attention: Congress’s failure to renew a bipartisan program that has helped save 25 million lives in its nearly 20-year history.
First authorized in 2003, the U.S. President’s Emergency Plan for AIDS Relief is one of the most hopeful examples of what bold, bipartisan leadership can accomplish. Yet as I write this, PEPFAR has not been reauthorized due to unfounded claims from conservative advocacy groups that the program helps support access to abortion in other countries (it doesn’t — but more on that later).
In the late ’90s and early 2000s HIV/AIDS was ravaging sub-Saharan Africa as well as many other parts of the world; many people lacked access to treatment. As a disease associated with sex and sexuality, AIDS was shrouded in stigma, shame, and silence; many churches in Africa (and, for that matter, in the U.S.) initially responded with fear and judgment rather than compassion and justice. With the cost of antiretroviral drugs being prohibitively high, the political and public health establishment viewed providing treatment in low- and middle-income countries as either not feasible or cost effective. And while groups like Partners in Health and Doctors Without Borders had already shown how HIV/AIDS treatment could be done in the global South, the political and moral will to fund such a program at an international scale was sorely missing.
Enter President George W. Bush’s 2003 State of the Union address in which he announced what became PEPFAR as “a work of mercy beyond all current international efforts to help the people of Africa.” As Bush explained earlier this year, Mike Gerson, his speechwriter, was one of the people who played an integral role in convincing Bush to develop the groundbreaking initiative. An evangelical Christian, Gerson said his faith compelled him to see the AIDS crisis as a humanitarian and pro-life issue. As Gerson put it in a 2017 op-ed when then-President Donald Trump had threatened to reduce PEPFAR’s funding: “Among evangelical Christians, what definition of being ‘pro-life’ does not include saving millions of lives from preventable disease and death?”
Several months after Bush’s address, PEPFAR was signed into law with support from both Democratic and Republican lawmakers.
But as is still the case today, bipartisan programs take effort — and bringing PEPFAR to life was no small feat. It required navigating a host of controversial issues such as the use of condoms and perceptions of the disease. It required enlisting the support of social conservatives. It required making an economic, a national security, and a humanitarian argument. It required raising awareness and galvanizing political will.
I had seen the devastation of HIV/AIDS and the hope that antiretroviral drugs offered while working in HIV prevention programs in Zambia in the summer of 2000. I returned to the U.S. convinced that the HIV/AIDS crisis would be a defining crisis for my generation and determined to mobilize both the church and college students in the fight against it. PEPFAR gave me an early and formative experience around how activism and movement building can change the course of a pandemic and unleash hope for millions. I’m proud to have been a part of efforts to build the “big tent” coalition of gay rights activists, physicians, people living with HIV, students, conservative Christians, and many others who together generated robust and lasting bipartisan Congressional support behind PEPFAR.
Unfortunately, as the program celebrates its 20th anniversary this year, our partisanship and polarized politics have put PEPFAR’s life-saving progress in the HIV/AIDS epidemic in jeopardy. A report issued earlier this year, by the Heritage Foundation, a conservative think tank, claims that PEPFAR is being used by Democrats to promote abortion. Other socially conservative advocacy organizations such as the Family Research Council and Susan B. Anthony Pro-Life America joined the chorus, with all three groups warning lawmakers that voting for a clean five-year reauthorization of the program would negatively affect their standing on the groups’ official scorecards — crucial tools that anti-abortion Republicans need to get elected. In June, Rep. Christopher H. Smith (R.-N.J.), who chairs a key foreign affairs panel in the House, changed his position on reauthorizing the program and funding has been stalled ever since.
According to people like Smith, the argument against PEPFAR boils down to the idea that its funding is fungible. In other words, it’s not that PEPFAR funding can be used to support access to abortion (by law, it can’t), but that a group receiving PEPFAR funding can use that infusion of cash to free up other sources of revenue to support abortions — or so the argument goes. However, that argument is undercut by the direct experience of faith-based organizations, both in the U.S. and abroad — who work with PEPFAR every day and know that it isn’t used to fund abortion.
Smith has argued that the Biden White House should reinstate the Mexico City Policy — an executive branch measure that prohibits foreign organizations receiving U.S. funding from supporting abortion access — which every Republican president since Ronald Reagan has instituted and every Democratic president since Bill Clinton has reversed. In my judgment, this gives the real game away: The agenda of these right-wing think tanks is to pressure lawmakers like Smith to leverage the success and bipartisan popularity of PEPFAR to make further gains on their agenda to restrict abortion access.
There must be room in our society for principled disagreement on the issue of abortion. Taking a program hostage that has saved 25 million lives to secure anti-abortion policy concessions is not what principled disagreement looks like.
Paul Farmer, the co-founder of Partners in Health spent his life applying God’s preferential option for the poor to the fight for health and human rights. When he died in 2022, I lost a friend and the world lost one of the most selfless and tireless champions for health as a human right. As he often said: “The idea that some lives matter less is the root of all that is wrong with the world,” and he challenged people to consider: “If access to health care is considered a human right, who is considered human enough to have that right?”
Through PEPFAR, the U.S. supports many of our nation’s best values of human dignity and the sanctity of every life. We can’t allow petty politics to sabotage our nation’s commitment to a program that saves lives and protects human dignity. To protect PEPFAR’s bold and important mission, we need to summon the same kind of persistence I witnessed that helped authorize PEPFAR in 2003, including letters to Congress, in-person lobbying visits, and op-eds in support of PEPFAR’s full authorization. These and other tactics are necessary again to ensure that we can reauthorize and sustain our global leadership.