PEPFAR and the death knell of bipartisan cooperation
Fighting HIV is now a front in the culture war, showing how the GOP has degraded since the Bush era.
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By Lisa Needham
George W. Bush didn’t do a lot right in his presidency. But he had one policy that has saved millions of lives — so of course modern Republicans want to get rid of it. It’s the latest evidence of the complete collapse of bipartisan cooperation, a collapse driven entirely by the GOP.
In his 2003 State of the Union, Bush proposed the US President’s Emergency Plan for AIDS Relief (PEPFAR), asking Congress to commit funding to fight HIV/AIDS worldwide. Congress originally allocated $15 billion for five years, and the law passed with overwhelming bipartisan support. In the ensuing 20 years, the US has spent $100 billion on global HIV/AIDS prevention, education, and treatment. It’s made a huge difference.
It can’t be overstated how grim the state of global HIV/AIDS treatment was in 2003. Though antiretroviral therapy, which controls the viral load of HIV, was becoming available in the United States in the mid-1990s, millions of people were dying worldwide. 2003 saw 3 million global deaths from AIDS, and 2.3 million of those deaths were in Sub-Saharan Africa. There were roughly 14,000 new infections per day in 2003, and over 95 percent of those cases were in low- to middle-income countries.
With PEPFAR, the United States made a commitment to the world. America has spent 20 years funding prevention efforts, testing, counseling, and drug treatments on a vast scale, resulting in 25 million lives saved. Currently, 20 million people across the globe receive antiretroviral treatment through the program. In 2022 alone, the program provided over 60 million HIV tests and covers costs for 1.5 million people on pre-exposure prophylaxis (PrEP), which reduces the risk of getting HIV through sexual contact by 99 percent.
All of these things are objectively good, which is presumably why Congress reauthorized the program three times. The most recent reauthorization, in 2018, passed the House and Senate by voice vote. Now, the future of the program is in jeopardy.
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The bleak Trumpist worldview opposing PEPFAR
Tim Meisburger, a former Trump official who lost his job at the US Agency for International Development for saying January 6 was nothing but “a few violent people,” wrote a report for the Heritage Foundation earlier this year “reassessing” the program, but really the report is a conservative rant. Meisburger throws everything against the wall, asserting that there are other diseases to deal with, that HIV/AIDS is no longer the global health emergency it was in 2003, and that it focuses too much on African countries.
The report then pivots hard to current conservative culture war discourse, complaining that the Biden administration is using PEPFAR as “a well-funded vehicle to promote its domestic radical social agenda overseas,” including abortion. Other conservative anti-choice groups like the Family Research Council and Susan B. Anthony List have climbed aboard, saying that PEPFAR is being used as “a massive slush fund for abortion and LGBT advocacy.”
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