Ensuring uninterrupted continuation of lifesaving HIV care and treatment services under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is the top priority for the program this year as the administration reviews foreign assistance. PEPFAR’s one-year reauthorization also expired March 25, suspending over 20 years of continuous bipartisan support through Republican and Democratic administrations, 12 Congresses, and four reauthorizations.
Since the Bush Institute’s last update on March 27, a significant portion of PEPFAR’s waived programming has resumed, but several partners and countries have reported continued challenges. This includes lifesaving HIV care and treatment services, prevention of mother-to-child transmission services, and select implementing agency and partner administrative costs.
Reauthorization affirms America’s commitment to a program that has saved more than 26 million lives and prevented nearly 8 million babies from contracting HIV. It also gives Congress the opportunity to maintain active oversight of the program.
What does it mean that PEPFAR hasn’t been reauthorized?
Even without reauthorization, PEPFAR will continue to work alongside partners across the globe to deliver lifesaving care – so long as funds are appropriated through Congress’ annual budget process. However, a series of congressionally mandated mechanisms that ensured that taxpayer dollars had the greatest impact also expired along with reauthorization.
They include the following:
- More than half of the appropriated funds must go toward treatment, care, and nutrition and food support for people living with HIV.
- No less than 10% of funds should be used for programs targeting orphans and vulnerable children.
- Limits the U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis, and Malaria to no more than 33% of all funds donated to the Fund during a specific period.
- Other transparency, monitoring, reporting, and oversight mechanisms that ensure
PEPFAR and its partners are utilizing taxpayer dollars efficiently and effectively.
PEPFAR has operated on a flat budget for over a decade and its funding is strictly allocated by Congress. Maintaining these provisions through reauthorization ensures that Congress has active oversight of PEPFAR and instills a set of checks and balances to make sure the program achieves its goals.
As PEPFAR moves closer to its goal of ending HIV/AIDS as a public health threat, it’s critical that PEPFAR-waived programing resumes as soon as possible – regardless of agency.
Once resumed, champions of the program in Washington have an opportunity to ensure that PEPFAR successfully reaches its goals and winds down to ensure country ownership and long-term sustainability. Reauthorization provides the optimal opportunity to develop a forward-thinking plan for PEPFAR’s future while continuing to save lives.
