How will Trump’s presidency impact HIV/AIDS funding?

NAIROBI - The President's Emergency Plan for AIDS Relief (PEPFAR) is a multi-billion-dollar HIV/AIDS programme that the U.S. government says has saved millions of lives globally since it was launched in 2003.

But domestic abortion politics have undermined the bipartisan support needed to continue funding the program.

Republican lawmakers in particular have recently prevented long-term funding of the program, and the election of Donald Trump signals an uncertain future to experts.

Here's what you need to know.

What is PEPFAR?

PEPFAR is the largest aid program to fight one disease that is funded by a single country. It began primarily in sub-Saharan African and has expanded to 55 countries across the world.

The U.S. has spent more than $120 billion to treat and prevent HIV/AIDS, saving 26 million lives and providing antiretroviral therapy to more than 20 million people with HIV, according to U.S. government data.

Since 2010, new HIV infections have been reduced by 57% in PEPFAR-funded countries, compared to 38% in all other countries, according to a 2023 UNAIDS report.

Why is PEPFAR funding uncertain?

PEPFAR was created by the U.S. Congress in 2003, a rare example of a policy with strong support from from both major parties. Its funding was renewed through five-year authorizations.

But it has come under threat more recently because of PEPFAR's partnerships with organizations that provide reproductive health services.

A 2023 report from the conservative think tank The Heritage Foundation accused President Joe Biden’s administration of using PEPFAR to promote "sexual and reproductive health rights" and "reproductive health services," which the report said were "code for abortion.”

No evidence has been produced to show that PEPFAR funds abortions, and U.S. laws prohibit foreign aid being used to fund abortion services. But the allegations sparked opposition to the programme from anti-abortion groups last year.

A coalition of U.S. anti-abortion groups wrote to Congress saying they were "concerned" that PEPFAR funds were being used to "promote abortions and push a radical gender ideology abroad."

Lawmakers and religious leaders from several African countries that receive PEPFAR funding sent a letter to U.S. Congress, with "concerns and suspicions" funding was being used to support abortion.

And Republican lawmaker Chris Smith stated before Congress that the Biden administration had "hijacked" PEPFAR to promote abortion.

"U.S. domestic political battles around abortion are very divisive, and [in 2023] that was used in a way to claim that PEPFAR was funding abortion," said Jennifer Kates of KFF, a nonprofit organisation focused on health policy.

"There is no evidence of that," Kates added.

What has changed for PEPFAR in the last year?

The outcry led Congress in 2023 to grant PEPFAR a one-year authorization. This September, Biden extended it until March 2025.

The issue has become so contentious that some anti-abortion groups threatened to "score" any Republicans who voted for a full reauthorization of PEPFAR as being pro-abortion, said Kates. "That made it almost impossible for Republicans in an election year to … vote to reauthorize PEPFAR.”

So far, Congress has maintained funding levels for PEPFAR, despite the lack of a long-term reauthorization.

How will Trump’s election impact PEPFAR funding?

Under Trump, further changes and challenges to PEPFAR's funding are likely, said Kates.

During his previous term, Trump reinstated and expanded a policy that prohibits U.S. funding to foreign organizations that perform or promote abortion, even with non-U.S. funds.

This has been criticized by health policy experts for limiting access to comprehensive reproductive health care, which is closely linked to HIV prevention and treatment.

Trump is now expected to reinstate similar policies, which could lead to funding constraints and disrupt critical services.

A Trump presidency might also reduce overall foreign aid budgets, including PEPFAR, as part of a broader shift toward a more isolationist U.S. foreign policy, said Kates.

"When [Trump] was president during his first term, he proposed really significant budget cuts to PEPFAR … I'd imagine that kind of thing will happen again," said Kates.

This story is part of a series supported by HIVOS's Free To Be Me programme.

(Reporting by Christine Mungai; Editing by Lyndsay Griffiths, Sadiya Ansari and Ayla Jean Yackley.)