African dark brown skin cupped hands holding red ribbon for HIV AIDS
Credit: Red Confidential / Shutterstock

The President’s Emergency Plan For AIDS Relief (PEPFAR) is one of those programs that’s so successful that many people have never heard of it. Initiated by President George W. Bush in 2003, PEPFAR has supplied the money and support to give antiretroviral therapy to people with HIV/AIDS around the world. PEPFAR has saved over 25 million lives over the last 20 years, and helped prevent untold millions of new infections.

Despite its success and longevity, it is not a well-known program. That’s because it has done its work quietly and efficiently, with few scandals to speak of. It has also enjoyed true bipartisan support, having been reauthorized every five years by both Republican- and Democrat-led governments. The ability to work outside of the political spotlight has been critical to the program’s lifesaving mission.

However, PEPFAR is now getting caught up in the culture war that threatens to consume all of American politics. PEPFAR is up for reauthorization again this year, but it’s facing increased scrutiny from conservatives thanks to a string of recent reports from the Heritage Foundation claiming that the program is in desperate need of reform.

PEPFAR represented a major deal between conservatives and liberals when it was passed in 2003. According to Emily Bass, author of “To End a Plague,” a book about the United States’ efforts to fight AIDS in Africa, part of the reason PEPFAR has achieved reauthorization is because that delicate balance struck 20 years ago has remained largely untouched.

However, the Heritage Foundation has launched its calls for change from several angles. It has accused PEPFAR of “neocolonialism” due to the program allegedly pushing “radical gender ideology;” it has questioned whether the $100 billion spent has truly benefited the sick or simply fueled the “PEPFAR industries” that receive funding; it has said that PEPFAR (and the US foreign policy establishment at large) is “monopolitical” and pushing Democratic ideals and priorities. Most damaging though is the assertion from Heritage that PEPFAR is being used to pay for abortions overseas.

As a result, PEPFAR is facing serious challenges to its five-year reauthorization for the first time. Conservative Republicans are now campaigning to change PEPFAR’s reauthorization to an annual event, and to add explicit anti-abortion language to the program. Foreign aid officials and medical experts fear annual reauthorization will weaken the program as it gets tossed around yearly according to political whims, while explicit anti-abortion language is a nonstarter for most Democrats.

PEPFAR officials have maintained that abortion is not funded by the program, but conservatives don’t believe them, because of course that’s what they would say. So let’s concede that  PEPFAR is a giant vehicle for leftist American values that puts cash directly in women’s hands for every abortion they receive. It’s a bastion of wokeism, warping the minds of sick people who accept cultural indoctrination to receive life-saving medicine. It’s a front for Planned Parenthood, burns recklessly through taxpayer dollars, and reports its outcomes directly to the Democratic National Committee. 

Isn’t that worth 25 million lives?

If the shoe was on the other foot, I’d be just as supportive of PEPFAR. If recipients of antiretroviral treatments had to sign Grover Norquist’s tax pledge or swear to never vote for a Democrat if they became American citizens someday, the program would still be an unmitigated good for the world and I would call for its reauthorization as is. Political purity is a nice concept in theory, but in reality, anything that could stop PEPFAR from existing as it has for 20 years could potentially cost lives.

Some might argue that the concerns about abortion go beyond simply politics. They would argue that they’re trying to stay true to PEPFAR’s life-saving mission by protecting all life, even the unborn. Again, whether the claims about abortion funded by PEPFAR are true or not is completely irrelevant. Let’s do the unpleasant math: is it worth trading X number of unborn babies for Y number of HIV/AIDS victims? Are politicians really ready to make that call on a program that has already done so much good? Shifting the moral calculus of PEPFAR 20 years in is baffling at best, and cruel to the people who depend on it for their lives at worst.

There’s no point arguing about whether Heritage’s claims are true, because we’ve long since passed the point where truth is relevant to policy. It comes down to a simple question: is political posturing over ideals worth more than 25 million people? I would argue it isn’t, and I urge Republicans and Democrats to pass PEPFAR, as is, to save more lives.

Jamil Ragland writes and lives in Hartford. You can read more of his writing at

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