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In 1997, the global AIDS crisis was growing more dire by the day. That year, I was on a mission as a Roman Catholic priest and social worker to help care for people with H.I.V. in Tanzania.
I witnessed pure horror. Death was a daily occurrence, from infants to adults. At the clinic where I was working in Dar es Salaam, our goal was to ensure no one died alone, and to treat the spiritual, psychological and physical pain that came with dying.
A turning point arrived in 2003, when President George W. Bush introduced the President’s Emergency Plan for AIDS Relief, PEPFAR for short, a multibillion-dollar initiative to combat the H.I.V. pandemic. The results were astounding: People who had come to the clinic to say goodbye before returning to their home village to die, came back to the clinic, and within weeks of receiving antiretroviral therapy, were on the way to regaining their health.
As a pro-life man of faith, I have witnessed the miracle of Lazarus over and over again. PEPFAR has meant that millions of H.I.V.-positive children and adults who were near death have been brought back to life.
And yet today, PEPFAR’s future is in peril: Some House Republicans refuse to move forward with a five-year reauthorization of the program in its current form because of evidence-free insinuations that it indirectly funds abortion. PEPFAR’s legislative authorization expires at the end of this month. Unless Congress acts urgently to renew it, the world could lose PEPFAR as we know it.
How did we get this close to the precipice for an initiative that has enjoyed enthusiastic bipartisan support for two decades? This spring, seemingly out of the blue, a small number of politicians and think tanks made this lifesaving program a target by launching disingenuous attacks based on falsehoods that have been disproved by people close to PEPFAR’s daily work and governance — including me.
The debate over PEPFAR kicked off in May when the Heritage Foundation, a conservative think tank, published a report that, without any substantiation, accused PEPFAR of “promoting” abortion. That same report callously referred to H.I.V. as a “lifestyle disease” and framed antiretroviral therapy as a partisan talking point. In doing so, it flouted not only consensus on how to end AIDS but also the Christian teaching that everyone deserves dignity and compassion. In the wake of the Heritage report, some prominent anti-abortion and conservative groups have said they will give negative ratings to elected officials who vote to reauthorize the program in its current iteration.
After working in Tanzania, I went on to manage two major PEPFAR-sponsored programs through the Catholic church in Namibia and Kenya, and at no point was abortion part of our work or our mission. If anything, we prevented women with H.I.V. from seeking abortions, by using PEPFAR funding and treatment to provide hope that they could deliver H.I.V.-negative babies.
Two laws, the Helms and Siljander Amendments, make it illegal to use taxpayer dollars to fund abortion in global aid programs or to lobby for or against abortion overseas, and PEPFAR programs are administered with significant oversight to ensure compliance with those laws. For years, the Office of the Inspector General has reviewed PEPFAR’s practices and has never discovered misappropriation of funds for abortion. Nor have outside researchers and experts. An evangelical anti-abortion leader in global health, Shepherd Smith, conducted his own assessment this year and reported that he found “no factual evidence” to support the “rumor” that PEPFAR has funded or in any other way promoted abortion.
Over the last 20 years, this ambitious program has saved 25 million lives in 55 countries, most of which are in Africa. AIDS deaths have dropped by 64 percent since 2004 in those countries. With a focus on comprehensive care, involving a patient’s family and community, PEPFAR has provided critical treatment and support to orphans, vulnerable children and their caregivers. It has enabled 5.5 million babies to be born without H.I.V. by preventing mother-to-child transmission of the virus. PEPFAR also has fortified education systems, helping girls stay in primary school, and stimulated economic growth in recipient countries.
Churches have championed PEPFAR since the early days of the program, and faith-based organizations, like the clinics and institutions where I served, play a major role in the development and administration of the program. In fact, faith-based institutions deliver 30 percent to 70 percent of health care services in low- and middle-income countries in Africa, according to one estimate. Faith leaders from the United States and around the world, including those who oppose abortion, have recently written letters calling for reauthorization. These leaders recognize that jeopardizing the future of PEPFAR disrespects the sanctity of human life.
It is possible that Congress will fund PEPFAR in the short term without approving a full five-year reauthorization. But that would be an unfortunate outcome, too. The program would be left in a vulnerable position that would undermine work with partner governments and institutions and would signal to the rest of the world that our country’s global leadership and commitment to defeating AIDS is waning. And key provisions, such as those that provide services for orphans, would expire.
Despite the impressive successes of PEPFAR, we still have a way to go in the fight against AIDS. Around the world, someone dies from an AIDS-related illness every minute, and only about half of H.I.V.-positive children who need treatment are receiving it. AIDS persists as a leading cause of death among young women in sub-Saharan Africa. Experts warn that we have fallen off track in the quest to end AIDS by 2030. Weakening PEPFAR would all but guarantee we fail to do so.
I remember the days before PEPFAR. We cannot go back to an era when nearly an entire generation was wiped out across Africa. We have come too far in the effort to end AIDS to abandon the course now. Letting PEPFAR lapse would fail to honor the teaching that all human life is sacred and worthy of protection.
Richard W. Bauer is a Roman Catholic priest with the Maryknoll Fathers and Brothers, hospital chaplain and social worker in Washington.
Source photograph by Shana Novak, via Getty Images.
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