The White House wanted cuts to the global HIV/AIDS program PEPFAR, and in a rare pushback, congressional Republicans said no.
After months of advocacy from faith and global-health communities, Congress decided in last minute negotiations this week to restore $400 million in funding to the program.
PEPFAR was the only foreign aid program to win a reprieve in a package Republican lawmakers designed to pull back previously authorized funding to federal programs, also called rescissions.
The White House had pushed the PEPFAR cuts, with the rescissions package formalizing the Department of Government Efficiency (DOGE)’s targeting of foreign aid earlier this year; about $8 billion of the $9 billion in cuts that Congress passed late Thursday night came from USAID (US Agency for International Development) funding.
Advocates saw PEPFAR’s reprieve as a symbolic win that the program has bipartisan support going forward.
“It was a great shot in the arm that the outreach done by the faith community, the advocate community, is really working,” said Catherine Connor, the vice president of public policy at the Elizabeth Glaser Pediatric AIDS Foundation, in an interview with CT. The organization is a major implementer of PEPFAR.
PEPFAR, or the President’s Emergency Plan for AIDS Relief, is a roughly $6.5 billion program that contracts with some Christian clinics and relief groups and supports about 20 million people on life-saving antiretroviral drugs. It launched in 2003 with bipartisan support and has saved more than 26 million lives around the world.
The biggest slice of PEPFAR’s budget goes to buying antiretroviral drugs and other medical supplies, and organizations implementing PEPFAR on the ground have reported to CT that drug supply disruption has been one of their major issues this year.
Those fighting HIV/AIDS have had a goal of ending the disease as a public health threat by 2030, but the administration’s drastic cuts brought the likelihood of achieving that into question. The Trump administration largely shuttered USAID, which oversees half of PEPFAR’s funding, and the State Department absorbed the agency’s remaining staff and programs.
After the Trump administration proposed the $400 million in cuts to the program, some Republican senators, led by Maine’s Susan Collins, pushed back.
The White House relented.
“PEPFAR will not be impacted by the rescissions,” said White House budget director Russell Vought, who has overseen the slashing of federal agencies, in the Capitol on Wednesday.
Shortly before the White House reversed its position on PEPFAR cuts, Family Research Council’s Tony Perkins published an op-ed supporting the $400 million cuts and pushing the administration to cut further. Perkins wrote that the program had been “co-opted to promote abortion access and LGBT ideology abroad” and that it was funding “pastry cooking for male prostitutes.”
Under the Biden administration, some conservative evangelical groups attacked the program as a “slush fund for abortion,” and national pro-life groups said they would consider votes in favor of PEPFAR’s five-year reauthorization as not pro-life.
PEPFAR did find violations of US law against abortion funding in one place: Mozambique, where four nurses had performed 21 abortions. It was the first time any abortions in the program had been found in 20 years. The US froze funding to the providers when it discovered the violation.
A recent study published in The Lancet estimated that the overall drastic cuts to USAID, including PEPFAR, would result in 14 million deaths of adults and children in the next five years.
Even with the restoration of PEPFAR funds, “The global health apparatus and the general development platform is being hit hard,” said Connor.
USAID programs that treated tuberculosis, malaria, and malnutrition have been slashed. This week, Republican lawmakers added language to the rescissions package to try to protect some of that care. They circulated an outline, reviewed by CT, about the amended rescissions package promising that it would protect “lifesaving HIV/AIDS, Tuberculosis, Malaria, Maternal and Child Health and Nutrition (including polio)” as well as “U.S. commodity-based food aid.” Food for international malnutrition programs comes from US farmers.
But it’s unclear how those programs are protected, since the $400 million for PEPFAR was the only program specifically saved from the rescissions.
“We’re thankful for the many Christians who have used their voices to advocate for PEPFAR in recent days, making telephone calls and sending emails to their congressional offices,” said Matthew Soerens, vice president of advocacy and policy at World Relief, in a statement. “It’s clear that many Senators’ offices were listening to these constituents’ perspectives, and I’m especially grateful for the leadership of Senate Appropriations Committee Chairwoman Susan Collins.”
On the ground, cuts have already done damage. But those working on PEPFAR weren’t expecting a win.
Patricia Kamara, the head of the Christian Health Association of Liberia, had gone to congressional offices to lobby for PEPFAR and other global health funding last month. CT spoke to her in Washington at the time, and she was discouraged. Essential drugs have been difficult to obtain in Liberia since the cuts, she said.
The sudden cuts felt like “stabbing in the back,” she said, but Christian facilities would find a way to stay open and serve their patients.
Kamara and others will continue looking for funding wherever they can find it. President Donald Trump’s budget for fiscal year 2026 has proposed deep cuts to PEPFAR and global health, in addition to the rescissions.
“It takes a lot of effort to keep pushing back against the political headwinds,” said Connor. “The good news here is Congress has sent a strong signal this week that they value PEPFAR’s work and they want to continue to support life-saving work.”
