Twenty years ago, in 2003, President George W. Bush created the President's Emergency Plan for AIDS Relief, or PEPFAR. Since its creation, PEPFAR has saved 25 million lives, significantly helped reduce mother-to-child HIV transmission, and increased access to antiretroviral therapy in more than 50 countries. Uniquely, PEPFAR has leveraged health funding as a tool of diplomacy that has served as a symbol of the United States' moral leadership in the world (Stolberg, 2023). That leadership is now under threat due to politics. PEPFAR is under threat due to abortion politics.
At the time of writing this editorial, PEPFAR is scheduled to end at the end of September 2023. Since its inception, PEPFAR has received significant bipartisan support (Stolberg, 2023). It has had "clean" reauthorizations (meaning one without policy restrictions) since its inception. And here is where abortion politics are yet again rearing their ugliness. Three conservative and highly influential policy groups that oppose abortion-the Family Research Council, the Heritage Foundation, and the Susan B. Anthony Pro-Life America-are trying to influence members of Congress with the threat of lowering their "scores" when they release their annual report of ratings (Stolberg, 2023) unless members of Congress incorporate the "abortion gag rule" as a part of PEPFAR.
The "abortion gag rule" officially known as the Mexico City Policy was enacted by the Reagan administration in 1984. It is a US government policy that is reinstated under Republican Presidents and rescinded under Democratic Presidents (Kaiser Family Foundation, 2021). This policy requires that foreign nongovernmental organizations certify that they will not "perform or actively promote abortion as a method of family planning" (Kaiser Family Foundation, 2021, third paragraph). During the Trump administration, the Mexico City Policy was expanded and applied to PEPFAR, maternal and child health, malaria, nutrition, and other US programs. The Biden administration reversed, or rescinded, these restrictions. However, with Republicans controlling the House of Representatives, they are trying to restrict funding PEPFAR unless the Mexico City Policy is integrated into PEPFAR reauthorization.
Similarly, at the domestic level, there is also politicalization of public funding for the Ending the HIV Epidemic in the U.S. (EHE) Initiative. To the surprise of many, the Trump administration proclaimed an ambitious goal to end the HIV epidemic in the U.S. (Miller & Whitehead, 2023). Now, that ambitious goal is under threat as a group of conservative Republicans are moving to cut funding to several agencies that support the EHE Initiative. Two agencies which help fund the EHE Initiative under budgetary attack include the Centers for Disease Control and Prevention (CDC) and the Ryan White HIV/AIDS Program administered by the Health Resources and Services Administration (HRSA) (Miller & Whitehead, 2023).
It is unlikely that PEPFAR and the EHE will be unfunded as both programs have benefited from broad bipartisan support in both chambers of Congress. Even if the Republican controlled house passes such legislation, it will likely fail in the Democrat-controlled U.S. Senate. However, even the threat of defunding such global and public health programs illustrates the politicization of public and global health, which is beyond absurdity. Even Kyle McGowan, the former chief of staff at the CDC during the Trump administration, labeled these potential cuts in health spending as "not smart"; in addition, he highlighted that "culture wars are now leaking into and harming public health" (Miller & Whitehead, 2023, seventh paragraph).
This editorial was written before the looming government shutdown scheduled to happen on October 1, 2023 if the necessary appropriation bills that fund the U.S. government's operations for the next fiscal year are not passed. Using PEPFAR and the EHE Initiative as political pawns in the process of budget negotiations is completely unacceptable. As the nation's largest and most trusted health profession, the nursing profession must continue to use its voice and political clout to advocate for funding for HIV prevention, care, and treatment both domestically and around the globe. Defunding PEPFAR and the EHE Initiative would be disastrous on so many levels. Thus, ANAC members are encouraged to contact their members of Congress by calling the United States Capitol Operator at 202.225.3121 and asking to be connected to your local Congressperson or the Senators from your home state or jurisdiction. Once connected, please ask to speak to the legislative aid in charge of health affairs. Then, introduce yourself as a professional nurse and as a member of the Association of Nurses in AIDS Care and indicate that you are concerned about the politicization of domestic and global HIV programs and public and global health. Please indicate that reauthorization and full appropriation of PEPFAR without restrictions and the EHE Initiative is fundamental from a moral perspective, a humanitarian perspective, a human rights perspective, and a public health perspective. Thank you in advance for using your professional clout and voice to advocate for HIV prevention, care, and treatment programs.
Disclosures
The authors report no real or perceived vested interests related to this article that could be construed as a conflict of interest.
Author Contributions
M.V. Relf was involved with the conceptualization, writing the original draft, and review and editing.
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