How a political battle is threatening a federal program that fights HIV

Read the Full Transcript

• John Yang:

  The federally funded President's Emergency Plan for AIDS Relief, or PEPFAR, provides HIV prevention, treatment and education around the world. It's the biggest commitment of any nation to fight a single disease. It's estimated to have saved 25 million lives since President George W. Bush launched it in 2003.

  Throughout its existence, PEPFAR has enjoyed broad bipartisan support on Capitol Hill. That is, until this year. A small group of conservative House Republicans is blocking legislation to reauthorize PEPFAR. They say the Biden administration is using it to promote abortion overseas. PEPFAR's supporters say there is no evidence to back that up.

  In September, President Bush wrote an op-ed in the Washington Post urging Congress to reauthorize the program. He wrote, there is no program more pro-life than one that has saved more than 25 million lives.

  Jennifer Kates is senior vice president and director of Global Health and HIV Policy at KFF. Jennifer, let's start with the basics. What does PEPFAR do and where does it do it?

• Jennifer Kates, Senior Vice President, KFF:

  So PEPFAR, the global AIDS response of the U.S. government, is a very large, it's the largest program in global health that the U.S. has and one of the largest in the world. And it provides funding support to many countries around the world, about 50, to launch and deliver HIV services, whether that's antiretroviral treatment, prevention, social support, education, working with countries, working with partners on the ground.

  And it's widely known as one of the most successful programs in the world. As you said, it's saving 25 million lives. And our analyses have also showed that it's had even broader impacts beyond HIV.

• John Yang:

  What are the things about it that has made it so successful and so effective?

• Jennifer Kates:

  When it was launched with incredible bipartisan support. And having that bipartisan support has really lent the program the kind of support and ongoing stability that it's needed.

  In addition, the program has been funded pretty well by Congress. And also one of the unique things about it is it's been very focused on data and metrics. So it has actually made changes over time, when new treatments have come on board, when it's seen that it needs to focus on a different area. So it's very driven by the science, driven by the data, and a very large commitment that involves multiple agencies across the U.S. government.

• John Yang:

  You say it's gone beyond HIV and AIDS. During the COVID pandemic, did it use some of its organization and infrastructure to work on that?

• Jennifer Kates:

  So during COVID when essentially the world shut down the operation in countries where PEPFAR is also had to shut down for a large part. What PEPFAR was able to do, though, they were able to use that infrastructure to respond to COVID, because the infrastructure is there. The U.S. has already developed it in many countries. And it was an incredible example of taking something that, where the investment was HIV specific and being able to build on that.

• John Yang:

  Now the opposition to this, to PEPFAR, reauthorizing PEPFAR in Capitol Hill is being led by Representative Chris Smith of New Jersey, longtime ardent foe of abortion. He's now chairman of the House Foreign Affairs subcommittee that has jurisdiction over PEPFAR and listen to how he defends or explains his opposition.

  Rep. Chris Smith (R) New Jersey: I strongly supported PEPFAR when it was created in 2003, and I was the sponsor of the reauthorization of PEPFAR in 2018. Regrettably, it has been reimagined, hijacked by the Biden administration to empower pro-abortion international NGOs deviating from its life affirming work.

• John Yang:

  What do you say to that?

• Jennifer Kates:

  Yes, Representative Smith mentioned that he was a supporter, has been a supporter of PEPFAR. He really has been. And the program has been reauthorized three times. This would be its fourth.

  I think what has happened is the larger politics in the United States around abortion and the partisan differences between Republicans and Democrats have sort of taken over what has been a very bipartisan discussion.

  I think the important piece to know, though, is there's several U.S. laws that actually restrict the use of U.S. funding for abortion. PEPFAR doesn't fund abortion. It never has. There's no evidence that it has.

  This is really a broader issue around differences between the current administration's views on abortion and choice and that of those who are opposed to abortion.

• John Yang:

  And specifically, he's complaining about the Biden administration's repeal of what's called the Mexico City Protocol, not to use any funds to any group that provides abortion when it's in place.

• Jennifer Kates:

  And it's always been put in place by Republican presidents through an executive action, and then it's been rescinded or removed by Democratic presidents through executive action, is a policy that says when the U.S. is providing foreign aid to other organizations, to foreign NGOs, non-governmental organizations, it cannot provide any of that funding to organizations that use their own money or any other money, non-U.S. money for abortion related activities that are prohibited, that even are legal in their country, but may be prohibited under U.S. law.

  So basically saying we're not going to give you money for abortion because we can't fund abortion, but we won't give you money if you do anything else related to abortion.

• John Yang:

  Now, PEPFAR is established in permanent law. So what differences will it make if it doesn't get reauthorized?

• Jennifer Kates:

  Right. There's essentially two kinds of laws, reauthorizing laws and appropriations. And we always focus a lot on the money. That's the appropriation side. But there's these laws called authorizing laws or reauthorizing laws. Those create programs or continue programs or structure them or have requirements on them.

  PEPFAR was authorized as a permanent part of U.S. law. It doesn't end as long as Congress continues to fund it. So that's the good news.

  However, there are some requirements and specifications within the authorization. It's reauthorization that do end, and they did on September 30. So those were essentially requirements on how the program should fund certain things, and those are no longer requirements. This is a real symbolic departure from its past.

  And I think that's the main aspect right now that most are focused on by getting to a point where there can't be a bipartisan agreement to reauthorize it and what message that might send on the ground and to other partner countries.

• John Yang:

  Jennifer Kates of KFF, thank you very much.

• Jennifer Kates:

  Thank you.

Improved audio player available on our mobile page