Global AIDS program survives, but backers ‘not satisfied’

America’s global AIDS relief program has been authorized for another year in the bipartisan budget deal, but public health advocates say the single year sends a worrying signal about U.S. commitment on the issue moving forward.

The minibus passed by the House on Friday reauthorizes the President’s Emergency Plan for AIDS Relief (PEPFAR) through March 25, 2025, without adding any anti-abortion riders to the program that GOP lawmakers had called for. 

But it’s the first time the program has not been given a five-year extension. 

The Foundation for AIDS Research, amfAR, applauded the House passing reauthorization, but it added “a one-year reauthorization signals to other countries that ending the HIV pandemic is no longer a priority of the United States.”

Since it was launched in 2003, PEPFAR has become one the most successful arms of U.S. health diplomacy. Despite this, measures to reauthorize were absent from stopgap measures introduced in the months following its first-ever expiration in September. 

Margaret Spellings, president and CEO of the Bipartisan Policy Center, said she was “pleased but not satisfied” by the one-year extension. 

Even a short-term authorization will ensure stability for the program that has saved more than 25 million lives. But Katie Coester, associate director of public policy and advocacy at the Elizabeth Glaser Pediatric AIDS Foundation, said the single year included in the appropriations bill could create uncertainty in countries where PEPFAR operates. 

The provisions that expired last year dictate how PEPFAR funds are distributed, as well as how the U.S. contributes to the Global Fund to Fight AIDS, Tuberculosis and Malaria. If these provisions languish for much longer, it could discourage other donors from contributing. 

The short-term extension sets up another potential fight next year, which policy experts say is unwarranted given the program’s long history of bipartisan support and proven track record. 

“Any kind of uncertainty on the ground has implications,” Spellings said.  

“If ever there was a program that has proved its worthiness in a million reasons, saving millions of lives, establishing American leadership, fostering national security here and abroad, improving a sound model, challenging bilateral relationships. I mean, on and on and on. It’s a winner,” she added. 

The push to add new anti-abortion guardrails on PEPFAR partners was led by Rep. Chris Smith (R-N.J.), who wanted the so-called Mexico City Policy reinstated, barring foreign aid from going toward organizations that support abortion services. 

President Biden rescinded the Mexico City Policy in 2021. 

Smith’s demands effectively blocked the reauthorization of PEPFAR, but the program has continued to operate as normal. 

Coester said the program can withstand brief lapses in approval. But she warned transitioning to one-year reauthorizations would increase the chances of longer-term lapses, which could threaten its overall stability. 

“I think it reinforces that there’s still strong bipartisan support for the PEPFAR program,” Coester said of the authorization.  

“And it recognizes that U.S. leadership and the global HIV response is essential to ending the epidemic. We obviously really appreciate that Congress included the extension but are disappointed in that it falls short of what is needed for the PEPFAR program.” 

HIV and AIDS groups say criticism of PEPFAR from abortion opponents has been fundamentally misguided because program funds were not going toward groups that supported abortion.

While the Mexico City Policy was rescinded, the Helms Amendment in the Foreign Assistance Act of 1973 still prohibits foreign aid from funding abortions. 

“Groups who were attacking the program don’t understand it,” Coester said. “I don’t think they understand how it works. I don’t think they understand the good that it does.”

The Hill has reached out to Smith’s office for comment.