Top scientists, opinion leaders, civil society groups and politicians are calling on United States (US)  policymakers to vote in favour of the continued funding for the President’s Emergency Plan for AIDS Relief (PEPFAR). The voting process – known as a reauthorisation – is a routine process that happens on a five-year cycle. It was last reauthorised in 2018. The deadline for the next reauthorisation is the end of September 2023.

PEPFAR is the US government’s effort to combat the AIDS epidemic. It’s the single largest fund dedicated to a single disease. Since its inception in 2003 PEPFAR pumped billions of dollars into the AIDS response. Thanks to the programme, around 20 million people are on HIV treatment, 1.5 million have access to pre-exposure prophylaxis, and around 25 million deaths have been avoided. 

The programme has received long-standing support from both Republicans and Democrats. But PEPFAR’s continued mandate has been cast in doubt over anti-abortion sentiments in the US.  While PEPFAR does not fund abortion services, some opponents want to add restrictions that prevent funding of organisations that provide or even support abortion  have suggested changes to the laws.  

Reauthorisation not an issue before

The South African National AIDS Council (SANAC), says the country has been given a commitment to receive funding from PEPFAR for next year  – regardless of the outcome in  Congress.

SANAC spokesperson Nelson Dlamini tells Health-e News that he was certain that approval for funding would be granted by the US government because there would be a global outcry if they did not approve it.

“The reauthorisation is something that happens every year, it has never been an issue before. Even the past two American presidents approved it and signed it off. So to hear that certain Republican party members are raising the issue of abortions is quite astounding,” says Dlamini.

South Africa has one the world’s highest HIV prevalence rates. UNAIDS estimates that 17.8 of people between the ages 15-49 have HIV. The country also has the largest HIV treatment programme in the world. 

Many community-based organisations working in the districts with the highest HIV burden in South Africa receive funding from the PEPFAR Community Grants Program.  Dlamini says without the PEPFAR investment, the country’s healthcare system would be in trouble. 

“I can’t even begin to imagine what this country’s healthcare system would be like without PEPFAR funding, it would be a catastrophe,” says Dlamini.

A ‘perfect’ model 

US politician Ed Royce, who chaired the Africa sub-committee when PEPFAR was last authorised in 2018, says “PEPFAR was the most consequential and successful foreign aid programme in history”.

Royce was speaking at a gathering of opinion leaders, civil society groups and politicians in Washington D.C. Speakers are advocating for PEPFAR’s “clean reauthorisation” with no changes to the existing legislation.

He explains that through the networks and training set up within PEPFAR global health systems have become more resilient to shocks.

“Thanks to this programme we knew how to deal with Ebola (and Covid-19), and therefore we also know what the consequences will be if we don’t move forward with this reauthorisation,” says Royce.

Health professionals say reauthorisation of PEPFAR legislation is urgent and Congress needs to pass it to avoid a global nightmare.

“The weakening of PEPFAR would be a severe blow to both health outcomes and US diplomacy worldwide,” says Dr Monica Gandhi, an HIV physician from the Center for AIDS Research, University of California.

“We urge Congress to view holistically what is at stake when considering the reauthorisation of PEPFAR, which are lives saved from HIV/AIDS, strengthening HIV prevention efforts, global surveillance for emerging infectious diseases, pandemic responses, tuberculosis control, and compassion,” she says. -Health-e News