Public health advocates on Tuesday warned a House subcommittee against a 'chaotic, rapid retreat' by the U.S. from a flagship global HIV/AIDS initiative — a program that has saved over 25 million lives.
“We have the opportunity to have not only the legacy of the past 20 years but a tremendous diplomatic, national security, and economic success,” said the Center for Global Health Practice and Impact’s Mark Dybul, who testified before a House Appropriations Committee subcommittee Tuesday morning.
Dybul and one other witness testified in support of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), a program that was launched by former President George W. Bush in 2003 to tackle the HIV/AIDS epidemic and is currently under review by the Trump administration. While PEPFAR has largely enjoyed bipartisan support, recent controversy and a significant scale back in foreign aid has put the life-saving program in jeopardy for the first time in two decades.
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“I think all of us here would agree that PEPFAR was never meant to go forever,” Republican Rep. Mario Díaz-Balart said during opening statements of Tuesday's hearing.
In addition to concerns about PEPFAR’s end game, Díaz-Balart referred to a recent violation made by one of the program’s partner organizations in Mozambique.
“Under the Biden administration's watch, the PEPFAR program violated the Helms Amendment and used taxpayers' funds to pay for abortions for the very first time,” Díaz-Balart said, referring to a federal policy prohibiting the use of federal funding for abortions. “I was obviously outraged, to say the least, to learn of this shocking betrayal – funds provided by Congress to save lives were instead used to end lives.”
The violation had been discovered by U.S. officials last year after PEPFAR-funded nurses performed more than 20 abortions in three years. The nurses hadn’t received training in accordance with the Helms Amendment. In reconciliation for the violation, about $4,000 of the nurses’ salaries were reimbursed to PEPFAR by the Mozambique government.
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“It was an isolated incident,” Democratic Rep. Lois Frankel said. “This represents a tiny, tiny fraction of the PEPFAR $6.5 billion annual budget.”
Still, the violation resulted in Congress revoking PEPFAR’s usual five-year reauthorization and instead reauthorized the program for one year until March 25, 2025. While the Trump administration halted federal aid programs under its 90-day review, PEPFAR received a limited waiver to continue certain services.
Dybul, who led the implementation of PEPFAR, said he agreed with Congressman Díaz-Balart that the program would not exist forever.
“Africans want a transition; they are not looking for this to continue forever,” he said, adding that a proper transition would “maintain gains.”
“We do want to transition from financing over time, but we want to transition to stronger economic national security diplomatic partners,” he said. “We have an opportunity to have a massive win for the United States.”
Dybul offered that “tangible, accountable benchmarks" for PEPFAR could make for a smooth transition to domestic funding in as little as two years for countries like South Africa.
PEPFAR currently supports more than 20 million people through HIV prevention and treatment services primarily in Sub-Saharan Africa; has partners in more than 50 countries; and has prevented 7.8 million babies from being born with HIV. The program has cost over $100 billion in funding since 2003.
As the Trump administration cut nearly $60 billion in foreign aid and grants, many critical health programs across the world came to a complete halt. Public health advocates told Scripps News the chaotic pullout from countries has led to disastrous effects.
Catherine Connors, vice president of public policy and advocacy at the Elizabeth Glaser Pediatric AIDS Foundation and the second witness at Tuesday’s hearing said that while PEPFAR received a limited waiver to continue its services, many were still disrupted. Connors also referred to a new report about the potential impact of an abrupt end to PEPFAR programs.
According to the analysis from the medical journal Lancet, “nearly 500,000 children could die from AIDS-related causes by 2030 without stable PEPFAR programmes.”
The authors of the analysis recommend a five-year transition plan to avoid new pediatric HIV infections and deaths that could be prevented.
