Abortion Politics Threatens a George W. Bush-era AIDS Initiative – Bloomberg

Fierce opposition from conservatives is casting doubt on the future of PEPFAR, the 20-year-old global anti-AIDS initiative started by President George W. Bush. In exchange for a short-term extension of the program, Republicans have insisted on attaching anti-abortion provisions to any funding. Indulging these demands may be distasteful to Democrats, but allowing PEPFAR to lapse altogether would be even worse.

PEPFAR — formally, the President’s Emergency Plan for AIDS Relief — has been America’s main tool for fighting AIDS in the developing world, particularly Africa, since 2002. The program has dispensed $100 billion to purchase treatments, support local health systems and expand public awareness of HIV. It has helped prevent some 21 million deaths and reduced by 6 million the number of children born with HIV. It has also enjoyed bipartisan support: In 2018, both the House and Senate reauthorized it without even a floor debate.

Now that consensus has collapsed. Republicans say that President Joe Biden is using the program to fund abortions abroad, and have threatened to block its reauthorization. US law prohibits using PEPFAR to directly fund abortions. But critics say the administration is doing so through the back door. It has asserted in PEPFAR policy documents that “we cannot end AIDS if we deny people’s … sexual and reproductive rights” and that anti-HIV efforts should be integrated with reproductive health services, which it has defined to include “termination of a pregnancy.” Pro-life groups have warned legislators that a vote for PEPFAR would count against their “scorecards.”

Earlier this month, House Republicans voted to reauthorize the program through 2024 — on the condition that it adhere to the so-called Mexico City policy, which bans US taxpayer funds from going to foreign organizations that perform abortions or “actively promote abortion as a method of family planning.” The policy was first applied to PEPFAR under former President Donald Trump, but lifted by Biden when he took office.

Democrats have rejected the proposal and insisted on a clean, five-year extension. The impasse could unsettle US partners and jeopardize future investments in anti-HIV programs, at a time when the disease remains the leading cause of death for women in Africa. More to the point, strict application of the Mexico City policy would mean denying aid to many public hospitals and clinics that operate in countries where abortion is legal and which are often the sole providers of maternal health care.

Given the divisiveness of the abortion issue, Congress has for decades deferred to the occupant of the White House to determine whether and how to attach the Mexico City restrictions to foreign-aid programs. The House’s reauthorization bill, however, would enshrine the anti-abortion language into law – making it difficult, if not impossible, for future administrations to rescind it.

PEPFAR is too valuable to be held hostage to abortion politics. A bipartisan deal shouldn’t be beyond reach. Republicans should accept that some funding will support health organizations that treat AIDS but also provide reproductive services; in exchange, Democrats should accept tougher compliance measures and stricter language upholding the long-standing ban on directly funding abortions. A shorter authorization term would also mollify lawmakers who support the program but worry about an open-ended commitment that could crowd out other priorities.

For its part, the Biden administration should transition PEPFAR from an “emergency” relief initiative to one that fits within the broader US development agenda. Shifting oversight from the State Department to the US Agency for International Development could improve coordination with similar programs, place greater focus on building local capacity and help ensure that funds are spent prudently.

Measured by its life-saving impact, PEPFAR ranks among the most successful US foreign-policy initiatives in recent history. It’s in America’s interest, and that of millions around the world, that Congress save and strengthen it.

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