NAIROBI, Kenya — The graves at the edge of the orphanage tell a story of despair. The rough planks in the cracked earth are painted with the names of children, most of them dead in the 1990s. That was before the HIV drugs arrived.
Today, the orphanage in Kenya’s capital is a happier, more hopeful place for children with HIV. But a political fight taking place in the United States is threatening the program that helps to keep them and millions of others around the world alive.
The reason for the threat? Abortion.
The AIDS epidemic has killed more than 40 million people since the first recorded cases in 1981, tripling child mortality and carving decades off life expectancy in the hardest-hit areas of Africa, where the cost of treatment put it out of reach. Horrified, then-President George W. Bush and the U.S. Congress two decades ago created what is described as the largest commitment by any nation to combat a single disease.
The program, known as the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, partners with nonprofit groups to provide HIV/AIDS medication to millions around the world. It strengthens local and national health care systems, cares for children orphaned by AIDS and provides job training for people at risk.
Now, a few Republican lawmakers are endangering the stability of the program, which officials say has saved 25 million lives in 55 countries from Ukraine to Brazil to Indonesia. That includes the lives of 5.5 million infants born HIV-free.
At the Catholic-run Nairobi orphanage, program manager Paul Mulongo has a message for Washington.
“Let them know that the lives of these children we are taking care of are purely in their hands,” Mulongo says.
The issue of abortion has been a sensitive one since PEPFAR’s inception in 2003. But each time the program came up for renewal in Congress, Republicans and Democrats were able to put aside partisan politics to support a program that’s long been seen as the vanguard of global aid.
“Most eras in countries are measured by loss of life in war and famine and pandemic,” said Tom Hart, president of the ONE Campaign, a nonpartisan organization that worked with Bush, a Republican, to create the program. “This era has been measured in lives saved.” The campaign has published a letter from dozens of faith leaders to Congress calling PEPFAR “a story of medical miracles and mercy.”
But the bipartisan support is cracking as the program is set to expire at the end of September. The trouble began in the spring, when the Heritage Foundation, an influential conservative Washington think tank, accused the Biden administration of using PEPFAR “to promote its domestic radical social agenda overseas.”
The group pointed to new State Department language that called for PEPFAR to partner with organizations that advocate for “institutional reforms in law and policy regarding sexual, reproductive and economic rights of women.” Conservatives argued that’s code for trying to integrate abortion with HIV/AIDS prevention, a claim the administration has denied.
In language echoing the early, harsh years of the epidemic, Heritage called HIV/AIDS a “lifestyle disease” that should be suppressed by “education, moral suasion and legal sanctions.” It recommended halving U.S. funding for PEPFAR, saying poor countries should bear more of the costs.
Shortly after that, U.S. Rep. Chris Smith, a longtime supporter of PEPFAR who wrote the bill reauthorizing it in 2018, said he would not move forward with reauthorization this time unless it barred nongovernmental organizations that used any funding to provide or promote abortion services. He said he came to this decision after having extensive conversations with stakeholders involved.
And the threat from the New Jersey Republican comes with weight: He chairs the U.S. House Foreign Affairs subcommittee with jurisdiction over the program’s funding.
Because that proposal faces stiff opposition from congressional Democrats, Smith, with support from prominent anti-abortion groups, wants to cut PEPFAR’s usual five-year funding to one year if that ban is not included. He said that way the program would remain funded at its highest level — $6.7 billion — while allowing lawmakers to annually to revisit contracts with partners they believe may support or provide abortion services.
The proposal would also include a measure that requires at least 10 percent of funds to be directed to NGOs like the Nairobi orphanage, which targets orphans and vulnerable children affected by HIV/AIDS.
“It’s a false narrative that says that you can’t do (the program) year by year as we try to protect the unborn child,” Smith told The Associated Press.
But supporters of the program say that under existing U.S. law, partners are already prohibited from using its funding for abortion services. The head of PEPFAR, John Nkengasong, told the AP he knew of no instance of the program’s money going directly or indirectly to fund abortion services.