Lives Are At Risk as Anti-Abortion Groups Attack HIV Programme PEPFAR
A child with HIV takes a paediatric dose of antiretroviral medication.

One of the most successful US aid programmes, the US President’s Emergency Plan for AIDS Relief (PEPFAR) – which has saved 25 million lives in its 20 years of existence – is facing a right-wing backlash based on misinformation.

PEPFAR’s five-year budget is due for re-funding by the US Senate and Congress by 30 September, but there has been unprecedented right-wing mobilisation against it over the past few months by both US and African groups. 

Twenty million people living with HIV are currently on antiretroviral medication thanks to PEPFAR, which also channels the US contribution to the Global Fund for AIDS, Tuberculosis and Malaria.

PEPFAR’s key achievements in 2022

PEPFAR was started by Republican president George W Bush in 2003 and has enjoyed bipartisan support from both Republicans and Democrats.

But a group of US right-wing groups claimed in a recent letter sent to Senate and Congress leaders that PEPFAR grantees  “are using taxpayer funds to promote a radical sexual and reproductive health agenda”. Signatories include the Center for Family and Human Rights (C-FAM), Heritage Foundation and the Dr James Dobson Family Institute.

A similar letter was sent on 6 June to the same US Senate and Congress leaders by African politicians and religious leaders claiming that PEPFAR “is supporting so-called family planning and reproductive health principles and practices, including abortion, that violate our core beliefs concerning life, family, and religion”.

US Representative Chris Smith, who co-sponsored PEPFAR’s refinancing in 2018, has also joined its critics by recently claiming that the programme is being used to “promote abortion on demand”. 

Illegal for PEPFAR to fund abortion

However, it is illegal for PEPFAR to fund or support abortion, and abortion is illegal in most of the  African countries where it operates.

“PEPFAR has never, will not ever, use that platform in supporting abortion,” said Dr John Nkengasong, who heads PEPAR as the US Global AIDS Co-ordinator, as reported by Devex.

One of the PEPFAR grantees that have been singled out is DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe), which targets teenage girls in 16 African countries. 

Girls and young women are up to five times more likely to contract HIV than boys and men their age, and DREAMS offered HIV prevention services to 2.9 million adolescent girls and young women in 2022.

However, a C-FAM report claims that “in Malawi the program focused on young girls 12-14 years providing access to sexual and reproductive health services, which according to the Biden administration includes abortion”. 

Abortion is illegal in Malawi so this simply isn’t possible.

The group also singles out the Anova Health Institute, a respected South African organisation that works largely with government departments on HIV prevention, treatment and care and health systems strengthening.

It claims that Anova “promotes abortions to teens as young as 14” and had condemned ”laws enacted in US states that designate bathroom use based on biological sex”.

However, Anova CEO Dr Helen Struthers, told Health Policy Watch that her organisation “has always worked within the South African legal framework and within the terms and conditions of our grant agreements”.

“We have abided by the United States Government’s Various Codes of Federal Regulation and other restraints placed on the use of PEPFAR funds. Anova has never performed any abortions, nor has it actively promoted abortion as a method of family planning with PEPFAR or any other funds,” Struthers stressed, adding that Anova had supporting the South African government to put 400,000 more people on antiretroviral treatment in the past four years.

“These people are all playing with fire, and they’re playing with people’s lives, and there can only be one reason: political motivation to kill PEPFAR,” Mark Dybul, former US global AIDS coordinator, told Devex.

Monica Geingos, co-chair of the Global Council on Inequality.

Meanwhile, Namibian First Lady Monica Geingos, co-chair of the newly formed UNAIDS Global Council on Inequality, said that “PEPFAR has been an incredibly effective partner for Namibia, and has really contributed to some of our remarkable gains” against HIV. 

“Unfortunately, as the US moves into a political season, and as many countries move to political seasons, things like this tend to happen. And it’s a reminder again, for many countries to become more self-reliant when it comes to health financing,” Geingkos said in response to a Health Policy Watch question at a webinar on Tuesday organised by UNAIDS and the Financial Times.

However, Geingos added that misinformation “is not something that the Global Council can ignore” as it “can exacerbate and prolong pandemics when people don’t believe in science, when politicians behave and speak irresponsibly and when this starts to impact where money flows to.”

* Story updated to include Anova comment.

Image Credits: Paul Kamau/DNDi.

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