PEPFAR’s Success Requires Continued Support from Both Parties

Representative Barbara Lee, D-Calif., speaks during a World AIDS Day event in December 2022. (Jonathan Ernst/Shutterstock)

Representative Barbara Lee, D-Calif., has served in Congress since 1998, representing Oakland and parts of the Bay Area. The Californian was a lead sponsor in the U.S. House of Representatives for the 2003 bipartisan legislation authorizing the President’s Emergency Plan For AIDS Relief (PEPFAR). She remains a vocal champion of the effort to fight the spread of HIV/AIDS in sub-Saharan Africa and elsewhere.

The Mills College graduate spoke with The Catalyst about the successes of PEPFAR, as well as the program’s next hurdles. The latter include building and sustaining the clinics that communities in sub-Saharan Africa need to provide care. She also cautions against the temptation within both parties to turn inward, recalling that the fight against HIV/AIDS is a national security challenge as well. Pandemics, after all, can destabilize nations and lead to authoritarian rulers who deprive citizens of their human rights and generate international conflict.

Why did you get involved in the fight against HIV/AIDS and what keeps you motivated?

My motivation is to see an end to the HIV/AIDS pandemic. We said we would get to an AIDS-free generation in 2030. We’re not at 2030 yet, so we have to keep at it. I am going to do everything in in my power to get there.

I have seen and met the first person who was treated with medications [from PEPFAR]. That was John Roberts in Uganda, back in 2003. He was very ill. I always think about him when I continue with this work. He was able with treatment to strengthen his health. Today, he is a high school teacher, married with five children, and an advocate for others to get tested and treated. So, John and the millions of other people who have gotten the health care they need motivates me.

What are the most critical gaps to ending HIV/AIDS in sub-Saharan Africa?

One of the most critical gaps is still the infrastructure, making sure that there is clean water and that there are roads and clinics. In some countries, the stigma also is overwhelming. We have to do more to help reduce that stigma. More public health education is important, especially with governmental leaders.

We also have to make sure that there’s a comprehensive approach to testing, education, treatment, care, infrastructure, nutrition, and all of the ancillary efforts that are required in countries in Africa, many of which are underdeveloped. Villages also are often far away from the urban centers. We need more access to those villages, so people do not have to walk 50 miles to get tested and receive their care.

How can Congress best help address those gaps?

Continuing to fund PEPFAR and the Global Fund [to Fight AIDS, Tuberculosis, and Malaria] and at the levels that we want and that we know will help is one way. But so is better coordination with a host country, making sure that the response is country-driven and that we look at other ways to boost resources in terms of food security, clean water, and climate.

We need to do this in a more intersectional and integrated fashion. And we need to make sure that the maternal-infant mortality rate has been reduced, at least with those children who were born with the virus.

We have to be a little bit more strategic, focused, and integrated in our approach.

President Bush discusses the HIV/AIDS Bill with, from left, Secretary of State Colin Powell, and Senators Joseph Biden, Bill Frist and Richard Lugar in the Oval Office, May 8, 2003. (Eric Draper / White House)

How do you make the case for PEPFAR in an era when there are temptations in both parties to turn inward?

COVID showed us what affects one affects all. This is a very small planet. We have lost over a million people to COVID in the U.S.  That shows what happens if you don’t see this as a priority or humanitarian concern.

Then look at our national security concerns and what happens here if we don’t respond to pandemics. Look at how the people in our own country are susceptible to viruses. These viruses travel. They don’t stay at home.

Looking inward is not a good place to be or a good strategy. We better look outward a bit more and realize that we’re part of the planet. We’re not just isolated from the rest of the world.

What do you see as PEPFAR’s role in stabilizing nations and local communities? Is that bringing greater transparency to countries? Elevating the cause of human rights as well as saving lives? How would you answer this?

I would say all of that, especially saving lives. But there still is a stigma. We have a lot of educating to do about the LGBTQI+ community. PEPFAR can lead on that because so many people in some countries stigmatize those and make it very difficult to survive and to live.

It’s a human rights issue, too. We have to help countries understand what the disease is about, but also help them understand that the Universal Declaration of Human Rights needs adhering to. The right to decent health care based on non-discrimination is extremely important. That’s one of the big issues we have to address.

Representative Barbara Lee and Bono promoting an AIDS-free generation (Photo Courtesy of Barbara Lee/Twitter)

What most stands in the way of PEPFAR creating greater stability in nations and communities? Is it authoritarian rulers? Inadequate funding? Something else?

It’s authoritarian rulers, yes, but you have the real threat of terrorism as a result of wars. There are terrorists now moving down from Northern Africa who weren’t around in the early 2000s. Despair creates the opening for terrorists to recruit. These young people who don’t have any jobs also don’t have any health care.

Part of what we have to do is learn how to help countries in their developmental needs. We have to take a whole-of-government approach on the continent of Africa, especially because the seeds of terrorism are sown in despair. This is a national security issue, and we have to convince our own members of Congress about that fact and then help those countries.

I visited Africa recently with General Michael Langley (Commander of the U.S. Africa Command). We have helped those countries stabilize and understand the benefits of democracy. But authoritarianism has taken hold once again in countries. We have to understand that it’s up to us to make sure that countries have the resources, NGOs, and governments to democratize in their own way.

In terms of our own Congress, how can this cause remain a bipartisan one?

Let’s go back to PEPFAR. Just as when the legislation authorizing PEPFAR passed in 2003, and President Bush was in the White House and Democrats were the minority in both chambers, we need everyone to come together to get the word out. President Bush, with his tremendous leadership. Former Senators [Bill] Frist and [John] Kerry. Speaker [Nancy] Pelosi. Bono. We need to make sure that both Democrats and Republicans understand the value of this effort.

The resources must be prioritized if we’re going to save lives, see an AIDS-free generation, and recognize the national security threats that emerge as a result of us not doing what we need to do. Again, this year is the reauthorization effort. We’re going to have to have a full court press with Democrats who were here back in the day. And they should come to Capitol Hill and begin to talk.

We know Democrats will stay firm on this. We have [House Appropriations Committee] Ranking Member Rosa DeLauro, D-CT., who’s very committed. And on the State, Foreign Operations, and Related Projects Subcommittee of the House Appropriations Committee, where I’m ranking member after serving as chair the last two years, we’re going to do everything we can do to keep it bipartisan and try to educate.

It’s basically educating members of Congress now about why this has to happen in a bipartisan way.