Toxic politics envelop noble AIDS program

Opinion editor's note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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"A work of mercy" is how former President George W. Bush introduced the nation in 2003 to a new global effort combatting AIDS and helping those afflicted with it.

In the two decades since, that program, known as the President's Emergency Plan for AIDS Relief (PEPFAR), has delivered magnificently on Bush's promise. It has saved an estimated 25 million lives through treatment, testing and prevention in countries once ravaged by this disease. Accomplishments also include 5.5 million babies born HIV-free to mothers infected with the virus that causes AIDS, and critical care and support to 7 million orphans and vulnerable children whose lives this still-fearsome disease upended.

This impressive track record is why PEPFAR has been a rare patch of common ground in Congress. Votes to reauthorize the program every five years since its founding have garnered wide, bipartisan support — until now. That's a disgraceful state of affairs necessitating swift remedy.

Unfortunately, PEPFAR is in the crosshairs of ill-informed abortion opponents in the House. Spurred on by a flimsy Heritage Foundation report, some allege that the Biden administration has "hijacked" the program to "promote abortion on demand in the developing world."

One apparent consequence: Lawmakers did not reauthorize the program in time to meet a Sept. 30 deadline. Congress can still do so, but its failure so far is raising questions about the nation's commitment to PEPFAR. That's a serious problem when the program relies on foreign governments and medical partners to provide lifesaving services.

The delayed funding is a substantial sum: more than $1 billion.

While new HIV infections have declined by 38% since 2010, and AIDS-related deaths by 51% during the same time, this virus is still a threat. In 2022, 1.3 million people were newly infected, according to UNAIDS. Globally, 39 million are living with HIV infection. This is no time for politics to undermine one of the world's most effective prevention and treatment programs.

"I think the holds are a more serious issue right now than the fact that Sept. 30 passed without reauthorization," said Jennifer Kates, KFF's senior vice president and director for global health and HIV policy, in an interview with an editorial writer. "They concern money that has already been appropriated and is needed by countries on the ground, so if the holds go on for a while, it could have implications for programs and services."

KFF, formerly known as the Kaiser Family Foundation, is a nonpartisan source for health policy, research and polling.

The Heritage report was written by a former Trump administration staffer who suddenly left his job in early 2021 after downplaying the Jan. 6 violence at the U.S. Capitol. In it, the author claims "code" words in Biden policy pronouncements indicate the program supports abortion or that it soon will. It's a dubious argument but one that some in Congress regrettably swallowed.

That update should reassure critics. In addition, there are multiple legal and policy restrictions acting as abortion guardrails, KFF's Kates notes. Among them: the Helms Amendment. Since 1973, this has banned "the direct use of U.S. funding overseas for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortion."

The political dysfunction enveloping PEPFAR has alarmed Minnesota medical experts and patient advocates.

Renowned epidemiologist Michael Osterholm praised the PEPFAR program, noting that it has saved millions of lives and millions of dollars by preventing infections and hospitalizations. He's worried the fight over PEPFAR suggests "we're going to see continued diminishing of public health capacity at the same time the problems are growing greater."

Matt Toburen, executive director of the Minnesota Aliveness Project, said PEPFAR is a model for global public health programs and that undermining it is "so shortsighted both from a humanitarian standpoint and from a disease control/public health standpoint."

Toburen, whose organization provides free support services to those living with HIV, also noted that the U.S. House Republicans' 2024 spending bill has proposed $767 million in spending on federal HIV programs.