Baranyai:

At the time he introduced it, George W. Bush didn't get a lot of recognition; at least not at home.

At the time he introduced it, George W. Bush didn’t get a lot of recognition; at least not at home. Nevertheless, the U.S. President’s emergency program for AIDS relief (PEPFAR) proved to be Bush’s greatest legacy, hands down. For a president whose tenure more often leaned into division, PEPFAR was a rare achievement of lasting bipartisan support. (The other was his signature education initiative, No Child Left Behind.)

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Established in 2003, PEPFAR provides life-saving HIV treatment in more than 50 countries around the world. During 20 years, the program has saved an estimated 25 million lives. It also shores up the U.S.’s rickety claim to moral leadership on the international stage. Congress’s ongoing support has been an unqualified good.

An estimated 40 million people worldwide live with HIV; about as many as have died from AIDS-related illnesses since the start of the epidemic. Antiretroviral therapies have transformed the diagnosis from a death sentence into a chronic, manageable condition for people who can access treatment. One in four still can’t.

Bush’s $7 billion legacy, re-authorized every five years, is currently set to expire at the end of September. Periodic renewal by Congress has been an easy win, until now.

Enter the forced-birth wing of the Republican party, which has been on a contact high since the Dobbs decision dismantled Roe v. Wade. They’ve watched as legal access to medically safe abortion care is squeezed out of existence, state by state. Not content to merely witness the devastation, they’ve been flexing their majority to inflict abortion restrictions far and wide.

They scored a win in July, adding abortion restrictions for military personnel to the National Defense Authorization Act (heretofore renewed annually with bipartisan support). They also threw in measures barring transgender care and diversity training, in line with the current spleen against “wokeness.”

Now, they’re holding up re-authorization of PEPFAR with a push to bar international partnerships with organizations that provide abortion-related services in their own countries.

It’s hard to proclaim a “pro-life” agenda while holding hostage medications that save millions of lives, but anti-choice extremists have long since made peace with such hypocrisy. Never mind if other nations consider abortion care and counselling important medical services for HIV-positive women making difficult choices about mother-to-baby transmission, and the infant toxicity of antiretroviral drugs. The forced-birth crowd squarely prioritizes the rights of the unborn over the needs of living, breathing children, to say nothing of their womb-bearing vessels.

Bush himself, upon taking office, used his very first executive order to block international family planning organizations from receiving U.S. aid if they provided any kind of abortion services — including counselling – even when funded with their own money.

Family planning organizations around the world faced a Hobson’s choice to cease providing critical health services to their communities, or to lose operational funding that helped keep the doors open so they could provide any services at all.

This hefty condition on family planning aid was first introduced by Ronald Reagan, during a 1984 trip to Mexico. The “Mexico City policy” was reversed by the Clinton administration before it was reinstated by Bush. The on-again, off-again policy has flipped each time the White House goes red or blue.

Even hard liner Bush never tied the Mexico City provisions to AIDS relief.

On Tuesday, the U.S. Secretary of State launched a new Bureau of Global Health Security and Diplomacy to prevent and respond to infectious diseases, including HIV. He called on Congress to re-authorize PEPFAR, without amendments. AIDS relief demands consistent and predictable funding. Millions of lives are too important to attach to a political football.

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