PEPFAR’s uncertain future spells crisis for global HIV/AIDS relief

USA — The fate of the US President’s Emergency Plan for AIDS Relief (PEPFAR), the world’s largest aid program for global health, hangs in the balance as the US Congress failed to reauthorize its budget by the September 30 deadline.

While it won’t immediately come to a halt, the program faces an uncertain future without robust bipartisan support.

“In the short term, PEPFAR will be able to continue providing the lifesaving prevention, care, and treatment services in partnership with PEPFAR-supported countries,” affirmed US State Department spokesperson Matthew Miller.

“However, the fact that Congress did not reauthorize the program sends a message to partners around the world, especially in Africa, that we are backing down from our leadership in ending HIV/AIDS as a public health threat.”

Despite the Biden administration’s support for a “clean” five-year PEPFAR reauthorization, certain program authorizations have already expired.

The exact implications of this are still being deciphered, but Miller assured that the program could persist for now as long as Congress allocates funds annually.

However, this could mean shifting from more sustainable five-year programs to annual budgets, introducing uncertainty and administrative challenges.

Seven requirements are set to expire after the 2023 financial year, with one more following suit in 2024, as identified by the Kaiser Family Foundation (KFF).

PEPFAR, a lifesaving initiative, has garnered bipartisan support for years, but recent months have seen efforts to link its grantees to abortion promotion, despite US legislation expressly prohibiting PEPFAR from funding or supporting abortion. This campaign has caused tension and uncertainty.

A group of influential right-wing groups in the U.S., including the Center for Family and Human Rights (C-FAM), the Heritage Foundation, and the Dr. James Dobson Family Institute, claimed that PEPFAR grantees were promoting a “radical sexual and reproductive health agenda,” although PEPFAR is expressly forbidden from such activities.

A similar claim was made by conservative African politicians and religious leaders, primarily Catholics, further complicating the program’s standing.

US Representative Chris Smith, a co-sponsor of PEPFAR’s refinancing in 2018, has also joined the critics, alleging that the program promotes “abortion on demand.”

Instead of authorizing PEPFAR for five years, Smith proposed a one-year reauthorization with strict anti-abortion clauses, an approach that may face challenges in the Democrat-dominated Senate.

Dr. John Nkengasong, head of PEPFAR, emphasized the program’s importance, having saved an estimated 25 million lives over 20 years and significantly reducing new HIV infections and AIDS-related deaths.

However, he dismissed claims of PEPFAR supporting abortion, underscoring the urgent need to continue the program.

Dr. Uche Ralph-Opara, Deputy Chief Health Officer for Project HOPE, warned of dire consequences if PEPFAR’s authorization is not renewed, stating that “lives are hanging in the balance.”

PEPFAR is not just a program; it’s a lifeline for millions, and its absence could lead to increased mortality rates and setbacks in the fight against HIV/AIDS.

USAID Administrator Samantha Power highlighted the significance of PEPFAR’s bipartisan support, emphasizing its stability and impact on global health efforts.

PEPFAR’s investments of US$110 billion have strengthened health systems, aided disease surveillance, and played a crucial role in addressing COVID-19.

Winnie Byanyima, head of UNAIDS, stressed the importance of PEPFAR’s continuation, especially in countries heavily burdened by HIV.

She urged strong political leadership to achieve the goal of ending HIV by 2030, emphasizing the need to follow scientific evidence and prioritize at-risk groups.

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