Senate Republicans remain wary of eliminating the popular and successful global HIV/AIDS program PEPFAR, as they face down a July 18 deadline to vote on President Trump’s first tranche of rescissions requests.
In his rescissions request to Congress last month, Trump asked that $900 million budgeted for the President’s Emergency Plan for AIDS Relief (PEPFAR) be cancelled. The House has already passed Trump’s rescissions, and now the Senate must make the final move.
The historically bipartisan HIV program, which was started under President George W. Bush, has been subject to heightened Republican scrutiny in recent years. However, it still has staunch defenders on both sides of the aisle.
At the forefront of the opposition to eliminating PEPFAR is Sen. Susan Collins (R-Maine), chair of the Senate Appropriations Committee.
“I want to strike the rescission of funds for PEPFAR, which has an enormous record of success, having saved some 26 million lives over the course of the program, as well as preventing nearly 8 million infants from receiving AIDS from their infected mothers,” Collins said.
“So I can’t imagine why we would want to terminate that program.”
According to other GOP appropriators, support for PEPFAR among Republicans remains strong.
“I think most Republicans are probably pretty supportive of that particular component of the foreign aid that is delivered. It is about as successful as any foreign aid that we do authorize and appropriate for,” said Sen. Mike Rounds (R-S.D.).
Under the rescissions process, the Appropriations Committee can approve, disapprove or amend Trump’s request. With one week left to vote, lawmakers are still hammering out the finer details of the package.
“I think there’s discussions around more granular data,” Sen. Shelley Moore Capito (R-W.V.) said when asked where the program stood. “PEPFAR is a popular program, we know it’s made a big difference in the lives of a lot of people, and globally.”
Sen. John Kennedy (R-La.) said his colleagues were asking “good questions” about the planned cuts, adding that Trump’s budget chief, Russ Vought, would be back in the Senate next week to provide more answers.
“It’s going to be gut check time for a lot of people who’ve talked a great deal about how we need to reduce spending but never seem to want to get around to doing it,” added Kennedy. “You know, it’s kind of like going to heaven. Everybody wants to go to heaven, but nobody’s quite ready to make the trip. And I think it will be unconscionable if we don’t pass this rescissions bill.”
Congress has reauthorized PEPFAR four times throughout its history, but its reauthorization lapsed for the first time in its history last year when Rep. Chris Smith (R-N.J.) pushed for anti-abortion guardrails for program partners to be added.
A one-year reauthorization was ultimately passed, though this expired in March.
Abortion remains a sticking issue for some Republicans when it comes to maintaining support for PEPFAR.
Sen. Lindsay Grahan (R-S.C.), a longtime ardent supporter of PEPFAR, said he would be supporting the rescissions package after Vought told him of how some of the program’s funding was going towards abortion services.
It was reported earlier this year that PEPFAR-funded service providers in Mozambique had performed at least 21 abortions since January 2021, in violation of U.S. law.
Proponents of PEPFAR argue that the program produces impressive returns for the amount of funding it receives, accounting for less than 0.1 percent of U.S. spending. Across its 22-year history, PEPFAR funding has totaled more than $120 billion, with $6.5 billion allotted to it for the fiscal year 2025.
Not only has PEPFAR been credited with saving millions of lives, but it’s also considered one of the strongest components of U.S. foreign policy and soft power abroad.
“I saw firsthand about the diplomatic power that PEPFAR brings to our ambassadors in embassies all around the world,” said Jirair Ratevosian, former PEPFAR chief of staff and Hock Infectious Disease Fellow at the Duke Global Health Institute.
“Cutting PEPFAR shrinks America’s role on the world stage, and it’s basically like handing over influence to countries that don’t share our values,” Ratevosian added. “To me, that’s why it’s short-sighted and it undercuts our own security and our own global standing.”
David J. Kramer, executive director of the George W. Bush Institutes, warned that U.S. adversaries are likely to fill in any void left if PEPFAR is significantly diminished.
“China and Russia are waiting to take advantage should the United States falter or forgo its commitment,” Kramer wrote in a letter addressed to the Senate Appropriations Committee.
“Whereas PEPFAR focuses on saving lives, Chinese lending structures and health programming lack accountability, transparency, and long-term sustainability,” said Kramer. ”Russia has expanded its influence on the continent – breeding instability and violence and destroying infrastructure along the way.”
Still others argue that PEPFAR was always envisioned as a temporary program, with eventual control to be transitioned off to the countries where support is being given. According to
Ratevosian, transitioning the PEPFAR programs over to the more than 50 countries where it operates is already underway, but that process takes time and money.
“The administration says it wants PEPFAR to shift its focus towards country-led programming, so move the funding away from countries and have countries lead their HIV programming. But it then wants to gut $400 million, which is the very resources PEPFAR needs to make that kind of transition happen in the first place. So, to me, it’s like slashing the tires and asking the driver to speed up,” Ratevosian said.
