by Tom McClusky and David Christensen

In his State of the Union address on January 28, 2003, President George W. Bush announced the President's Emergency Plan for AIDS Relief (PEPFAR). PEPFAR is the largest commitment ever by any nation for an international health initiative dedicated to a single disease -- a five-year, $15 billion, and multifaceted approach to combating the disease around the world. The United States now leads the world in its level of support for the fight against HIV/AIDS.

During his 2008 State of the Union address, President Bush highlighted the successes of PEPFAR and once again called on Congress to reauthorize the program for an additional $30 billion over five years. He noted:

...America is leading the fight against disease. With your help, we are working to cut by half the number of malaria-related deaths in 15 African nations. And our Emergency Plan for AIDS Relief is treating 1.4 million people. We can bring healing and hope to many more. So I ask you to maintain the principles that have changed behavior and made this program a success. And I call on you to double our initial commitment to fighting HIV/AIDS by approving an additional $30 billion over the next 5 years. ...

Some of the successes of the PEPFAR program (from www.pepfar.gov )

  • Globally, the Emergency Plan supported life-saving antiretroviral treatment for approximately 1,445,500 men, women and children through September 30, 2007.
  • The Emergency Plan supported life-saving antiretroviral treatment for approximately 1,358,500 men, women and children through bilateral programs in PEPFAR's 15 focus countries in sub-Saharan Africa, Asia and the Caribbean.
  • Of the people receiving antiretroviral treatment through direct U.S. Government (USG) support in the focus countries, nearly 86,000 are children age 14 and under; a 77 percent increase over the number of children on PEPFAR-supported treatment in 2006.
  • In the focus countries, 62% of the individuals on antiretroviral treatment as a result of direct PEPFAR support are women and girls.
  • Community outreach activities that promoted Abstinence and Be-faithful programs reached more than 40 million people. Of these activities, nearly 11 million individuals-primarily children-were reached by abstinence as their primary behavioral objectives.
  • When President Bush announced PEPFAR, it was estimated that only 50,000 people were receiving treatment for HIV/AIDS in sub-Saharan Africa.

Chairman Tom Lantos (D-CA) of the House Committee on Foreign Affairs is circulating draft legislation to reauthorize the President's Emergency Plan for AIDS Relief (PEPFAR). Chairman Lantos' bill turns what was a successful tool in the fight against AIDS into a $50 BILLION slush fund for pro-abortion groups worldwide. It is essential to ensure that the resources are spent on evidence-based programs that have proven to be successful and that respect the pro-family, pro-life cultures of the countries in which they are implemented.

The following summarizes the critical issues to be addressed during the PEPFAR reauthorization process:

The bill completely undermines the abstinence prevention programs by removing the carefully negotiated prevention provision that requires a third of prevention funds to be spent for "abstinence-until-marriage" and "be-faithful" programs. In 2006, to prevent the sexual transmission of HIV, PEPFAR supported abstinence and faithfulness activities reaching over 40 million people. These programs help prevent the spread of HIV/AIDs by reducing multiple partners and encouraging individuals to abstain from risky behavior until marriage. The draft bill would virtually erase these prevention programs.

In addition, the draft bill removes the current provision requiring recipients of PEPFAR funds to certify their opposition to sex-trafficking and prostitution, a provision that has been upheld by the U.S. Court of Appeals for the District of Columbia (a case in New York is still pending). This provision is important to prevent the spread of HIV/AIDs. As the Appeals Court wrote: "It would make little sense for the government to provide billions of dollars to encourage reduction of HIV/AIDS behavioral risks, including prostitution and sex trafficking, and yet to engage as partners in this effort organizations that are neutral toward or even actively promote the same practices sought to be eradicated."

The bill increases funding for the Global Fund from $1 billion to $2 billion per year without any transparency requirements. Indeed, there is strong evidence to suggest that the Global Fund has already funded abortion groups in China, known to be involved in China's egregious one-child policy enforced by coercive abortion and sterilization. We support an amendment to ensure transparency in the Global Fund.

While the conscience provision in current PEPFAR law has been maintained in the Lantos draft, the bill sets a priority on new family planning and reproductive health programs, thereby making the conscience provision moot. Faith-based organizations would not be required to offer services they oppose. However, there is nothing in the draft bill to prevent such groups from being discriminated against because they do not also provide family planning and reproductive health services, which the bill integrates with the HIV/AIDs prevention and treatment programs. The bill requires those involved in HIV/AIDs prevention programs to refer for family planning and reproductive health services (which could include abortion). The integration of HIV/AIDs prevention and treatment programs with family planning and reproductive health programs could undermine faith-based organizations continued involvement in PEPFAR.

The integration of "family planning" and "reproductive health" programs with HIV/AIDs programs would have an even more onerous result. The Lantos draft would fund abortion groups to carry out the new family planning or reproductive health programs. While the Mexico City Policy (MCP) currently prevents family planning funds in the Foreign Operations Appropriations bill from going to organizations that perform or promote abortion, MCP does not apply to PEPFAR. However, the current PEPFAR authorization does not fund family planning and reproductive health activities. By creating new family planning and reproductive health programs without including MCP, the new bill could create massive new financial support for international abortion providers. We strongly urge action to statutorily apply the MCP to PEPFAR funding. We should keep family planning and abortion separate, and we urge amendments to include MCP in PEPFAR.