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PEPFAR reauthorization debate highlights splits in GOP

Ariel Cohen and Sandhya Raman, CQ-Roll Call on

Published in News & Features

A key HIV/AIDS program that has enjoyed bipartisan support for more than 20 years is highlighting a post-Roe split in the Republican Party.

Eight provisions within the President’s Emergency Plan for AIDS Relief, or PEPFAR, that expire Sept. 30 are in jeopardy, entangled in an abortion debate that has some arguing the George W. Bush-crafted program could provide aid to abortion providers abroad.

Prominent anti-abortion groups are lobbying to prevent renewing the law in its current form, arguing that part of the program’s $7 billion annual budget goes to abortion providers. Supporters of the program say it does no such thing, focusing solely on HIV and AIDS.

Last week, Bush wrote an op-ed asking Congress to re-up the program. Other Republicans, including Sens. Lindsey Graham of South Carolina and John Boozman of Arkansas, and at least 14 in the House, have also called for a prompt reauthorization.

But Rep. Christopher H. Smith, R-N.J., who sponsored the program’s last five-year authorization, is now pushing a one-year reauthorization that would reinstate some anti-abortion restrictions as part of the State Department appropriations bill. Smith is the chairman of the House Foreign Affairs Committee’s Subcommittee on Global Health, Global Human Rights and International Organizations.

His reauthorization would reinstate an administrative action known as the Mexico City policy, which prevents an international group receiving U.S. funding from using any of its own funds for promoting or providing abortions.


President Donald Trump expanded the use of that policy in 2019 to apply it to all foreign nongovernmental organizations receiving global health assistance and their sub-recipients, even if the sub-recipients do not use U.S. dollars.

After President Joe Biden took office, he rescinded Trump’s expansion of the policy.

“We’re pro-life, we want to protect the victims of abortion and the victims of HIV/AIDS,” said Smith, who accused the Biden administration of “casting a false narrative” that antiretroviral HIV medicine will not be issued if the program expires. “That money will continue. We’re trying to get reforms on the policy side.”

Early momentum toward a clean reauthorization of the expiring provisions has stalled as conservatives are increasingly split on the future of a key part of Bush’s legacy.


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