Why is a Fund Set Up to Eradicate HIV Under GOP Scrutiny?

CHRISTIANE AMANPOUR, CNN INTERNATIONAL HOST: Turning now to the international effort to fight AIDS. 20 years ago, President Bush introduced one of the United States most successful foreign aid programs. It was called PEPFAR. The Plan for AIDS Relief has saved 25 million lives. But it is now under threat. House Republicans are opposing funding which expires at the end of the month over abortion politics. Steven Thrasher is an HIV and AIDS scholar and he joins Hari Sreenivasan to discuss the global impact of this relief and its removal.

(BEGIN VIDEO CLIP)

HARI SREENIVASAN, INTERNATIONAL CORRESPONDENT: Christiane, thanks. Steven Thrasher, thanks so much for joining us. Something that is interesting that has had bipartisan support has been PEPFAR funding. And for those who don’t know what PEPFAR stands for, it is the resident’s Emergency Plan for AIDS Relief. It was set up back in 2003 from President George W. Bush. It has been approved and reapproved over and over again, authorized, and it’s coming up for a reauthorization soon. Yet this time, it’s facing a little bit more partisan obstruction. Why?

STEVEN THRASHER, HIV/AIDS SCHOLAR: PEPFAR, the — as you said, was a bipartisan effort that has been pass many times and House Republicans are holding it hostage right now. They’re threatening to not renew the funding. They’re trying to use it as a way to shake down the federal government and make them put abortion restrictions on countries that are receiving this aid, which would be a disaster on many fronts. But it’s also important to remember that even though some very powerful people have weighed into this conversation, including George W. Bush himself writing in “The Washington Post” this week, they’re not only trying to get rid of PEPFAR funding which deals with U.S. funding for AIDS abroad. They’re also trying to get rid of several hundred million dollars-worth of AIDS funding domestically within the United States as well. And I think that’s part of the larger attack that they’re waging on LGBTQ rights and on bodily rights.

SREENIVASAN: All right. I want you to get to the domestic funding in a little bit. But one of the key concerns here from Representative Chris Smith of New Jersey who’s a Republican. He is the chair of a house panel that oversees PEPFAR and he has supported its reauthorization before. But he said the Biden administration has now injected abortion rights into the program. Tell me about this.

THRASHER: It pains me to agree with George W. Bush but he is correct in this instance. And there are many countries that get funding from PEPFAR, they’re across the world. Ukraine gets funding. Many countries in Africa, and some countries in Southeast Asia including Vietnam. So, they are wide variety of countries and they have many different approaches to abortion. I teach a class called “Sex and the American Empire”, and one of the things we look at is how the U.S. is trying to influence policy abroad. So, House Republicans are trying to having a really disastrous electoral effects for them for taking the stance they have on abortion. They’re now trying to force abortion right, sort of, the dial back of abortion rights in many different countries. And these countries, as I said, they have very, very different approaches in different places. But if they were successful, it would have a really disastrous impact because the same kinds of organizations and the same kinds of people who do work around abortion are also doing the most important work around STI prevention and HIV/AIDS prevention. And I thought it was interesting in George W. Bush’s op-ed that he really sides (ph) that. We have that quote about his program being pro-life, but he did not weighed in on abortion in other ways. He just said that that’s not worth discussing in this conversation, and that’s true.

SREENIVASAN: The head of PEPFAR recently told the “Associated Press” that he knew of no instance in which money was going to directly or indirectly fund abortion services. So, what is the work of this program look like on the ground?

THRASHER: In different parts of the world, the most important thing that it has in common is that it gets drugs into bodies. We’ve had medications that have successfully dealt with HIV since 1995. And in 1996, the United States rate of death went down dramatically, and we started saving tens of thousands, hundreds of thousands of lives inside the United States because we had access to that medication. But nobody else had access to it in much of the world outside of Europe for another seven years. And so, even as AIDS deaths went down starting in ’96 in the United States, they kept going up until 2003, 2004, up to about 2.5 million deaths a year. And that was because the drugs were simply too expensive for very poor countries and many modern income countries to afford. And so, PEPFAR both made the drugs available in — for free in some places, for much less money in some places. Worked with the drug companies to bring the cost down. But at a very — and there are all kinds of structural issues around AIDS that need to still be addressed, but at a very cellar level it got drugs into bodies, and that saved tens of millions of lives. So, nobody should be against that in any way. The only, sort of, bad thing about it was that as the U.S. was looking abroad during those years, they really neglected HIV and AIDS here in the United States, and that could happen again if a deal is cut around PEPFAR and not cut around the reinstating the domestic funding they’re trying to pull.

SREENIVASAN: Where is the, sort of, abortion fear come in, or abortion funding fear come in?

THRASHER: I think that with so much with the House Republicans, this is just a bone that they won’t let go of. So that they’ve seen that — they got, you know, after many decades of organizing, they’ve gotten Dobbs passed. They’ve gotten Roe largely repealed here in the United States. It’s been an electoral disaster for them. And it’s no longer working for them. They have nothing to really get their — the people that were coming out to vote for them to do so anymore. They kind of won that fight. But it’s not working for them. And so, they’re looking for other places to do it. And they also, I think, this has to be read in the context of their general anti-LGBTQ hatred that they’re waging upon the world. They’re doing as much of it as they can here in the United States. There are 400 anti-trans bills and anti-LGBTQ bills here in the United States. And they’re looking ways — for ways to punish LGBTQ people around the world, and this is one way. Of course, HIV and AIDS does not only affect gay and trans people. There are many countries in the world, including some of those who receive money from PEPFAR where the majority of cases either happen through injection drug use or through vertical transmission from parent to child during pregnancy. But it is a virus and a disease that affects LGBTQ people disproportionately. And the United States has been successful, unfortunately, in exporting many anti-LGBTQ laws and attitudes in terms of anti-gay laws through U.S. missionary work, through various different policies. And so, I think that this is another part of it that that’s part of what’s happening around the AIDS component of it.

SREENIVASAN: Some of the most recent round of critique of PEPFAR seems to be coming from a report that was authored by a conservative think tank called “The Heritage Foundation.” In that report, they say that HIV/AIDS is primarily, “A lifestyle disease.” So, what is the problem in framing it that way?

THRASHER: Lifestyle is a dog whistle on a couple of levels. It’s first saying that being gay or being trans is a lifestyle. And saying it’s something people just choose like the color of the shirt they wear or something like that. So, that’s one level that it’s at. And it’s also trying to say that people get AIDS because of their, you know, their lifestyle and the things that they choose to do. And that’s a really unfair thing to say on multiple levels. Certainly, looking abroad, people get HIV and AIDS because of structural issues. One of the reasons why we’ve continued to have so many cases here in the United States is because incarceration and homelessness are major drivers of why people get HIV and why HIV progresses on to AIDS. And so many countries in the world, especially those who are receiving money from PEPFAR, they’re not getting the support that they need to be able to stop this terrible virus from moving on between people. When somebody gets HIV medication, they become what’s called virally undetectable. They cannot transmit the virus on to other people. So, for those seven, eight years when the medication was available but people could not afford it and so much of the world, the virus was just moving and moving and moving through extremely normative human activities, the most normative being sex and reproductive sex. As I was saying earlier, there are countries that receive money from PEPFAR were the major way that people become HIV positive is through vertical transmission. They’re getting it through their parent while they’re pregnant and then they are born with HIV/AIDS. And so, it’s — of course, there’s nothing in the lifestyle of an unborn infant, of a newborn baby for these people who are so obsessed, they say, with the unborn. There’s nothing about their lifestyle that makes them become HIV positive. And even the adults who are becoming HIV positive it’s through completely normative human activities. So, writing it off to something that can just be changed by lifestyle is unfair. It’s stigmatizing. And it is side stepping the responsibility we have to bring this epidemic to a close if there’s the political well to do so because the medication there.

SREENIVASAN: You know, there are some Republicans that are calling for this authorization not to be once every five years, but to be every year. Is there a problem with that?

THRASHER: It’s a similar dynamic to things happening with the — here in the United States with the debt ceiling. You know, every time that these kinds of things can be held hostage, they will be. And AIDS and HIV are things that take long-term thinking, you know, we’re still in the COVID-19 pandemic. There are people who want to think about this pandemic being over even though we’re only about four years into it, but we first became aware of HIV for more than 40 years now and it’s still a pandemic. It’s still killing the better part of a million people for a year. And so, you cannot think about plans to mitigate that or end that year to year to year and have this be something that can be held over voters’ head, that can be held over Congress’ head every year. There should be reauthorization for an indefinite period of time until this, you know, until this epidemic is ended and brought under control.

SREENIVASAN: A lot of people might be familiar with how PEPFAR has impacted HIV and AIDS overseas. But what are the funding sources? What are the programs here in the United States that would be affected if PEPFAR funding was discontinued?

THRASHER: Well, here in the United States, PEPFAR is entirely a foreign program. But there’s multiple domestic programs here in the U.S. that the House Republicans are also trying to get rid of at the same time. The Ryan White CARE Act is a version of basically universal healthcare for people who are living with HIV. It’s had success for people who can get it. But the people who most need, the people who are most at risk, including those who are unhoused, the population that’s growing every year in this country, very rarely connect with the program. People who are incarcerated very rarely, you know, connect with the program and get the care that they need. So, it continues to move on. And then one of the most popular and really successful things that we’ve done here in the United States is program called PrEP for All. People who become positive with HIV take a form of medication, anti-viral medication PrEP which stands for pre-exposure prophylaxis is a drug that you can take every day, I take it myself, and it gives you the similar medication. But if you encounter HIV, it keeps it from taking hold in your body. And so, cities and states, particularly cities around the country, Los Angeles, San Francisco, Chicago, where I live, New York have had real success in getting PrEP out broadly to populations that are highly at risk. That includes young people of color who are LGBTIQ. People who don’t have insurance by other means. PrEP — targeted PrEP campaigns have also been really, really helpful in places where HIV has broken out in the — via the opioid epidemic. And people who might not think that they need to take an HIV prevention medication that becomes a factor in — when they go into a place where HIV is breaking out and really helps transmissions from happening. I don’t like to think in such crude economic ways. But this is actually a very money saving — it’s a very money saving expenditure because if you spend money keeping people from becoming HIV positive, it saves a lot of money downstream. But there are lots of conservatives who don’t like the idea of PrEP. They think that it’s a drug that makes people promiscuous. They think that it is allowing people to get away with something by not being punished for having sex. And so, taking away any of these tools would actually allow the virus to flow much more. Some of it would flow to people who are in high-risk populations. Some of it would just move on to people outside of high-risk populations. But the bottom line is that it would increase the number of people getting HIV and the number of people who would die of AIDS. And it’s really terrible seeing the enormous success some cities have had in bringing down to almost zero levels in populations that used to have really high levels of HIV. It would be terrible to roll that back now and to let HIV flourish in the United States more than medication could allow it to stop.

SREENIVASAN: We’re talking about the effects that policies have on lives. I’m reminded that in 2015, there was a needle exchange program that was opposed by Then-Governor Mike Pence of Indiana. And — because he thought that it condoned drug use. And we saw very rapidly an HIV outbreak of something close to 200 people in Scott County. And I’m wondering whether there are ripple effects that are measurable when funding decreases overseas or domestically and what we see epidemiologically in communities.

THRASHER: Certainly. And here’s where the importance of thinking about abortion and HIV becomes really, really clear. So, in Scott County, Indiana in 2014, 2015, as you said when Mike Pence was then the governor of Indiana had the fastest HIV outbreak that’s ever been recorded in the United States. Cases — they found the first case and then they went very, very quickly up. And scholars, including my friend, the Yale epidemiologist Gregg Gonsalves, initially looked at something that sort of darkly humorous. The question of, did those cases move quickly because Pence famously said he needed a few days to pray about whether or not to do a sterile syringe exchange. And what they found was that the cases didn’t increase that much in that moment. The major transmissions had already happened quite quickly. But why those cases moved so quickly was because there was no surveillance in the southern half of Indiana. And the reason there wasn’t surveillance is because Pence had been successful in running out of his state everybody who provided abortion. And it’s the people who provide abortion, the Planned Parenthood clinics, the private, the public clinics that help people get abortion that are also doing sexually transmitted infection prevention. They’re doing STI education. They’re doing LGBTQ sexual education. And they’re doing HIV prevention and HIV treatment. And so, when — if PEPFAR were to be repealed and to stop abortions from happening in other countries, and here in the United States, as Dobbs came in and Roe was repealed, we’ve seen 70, 80 clinics that provided abortions closed around in the United States, those places are also prime to be out — places where HIV will break out because the people who dealt with compassionately, professionally, and medically sound ways. People needing stigmatized healthcare, including abortion and HIV prevention, they’re no longer there. And if they’re not there, nobody is seeing the cases. And by the time you find out there’s an HIV case, it could have actually moved into many, many cases when it didn’t need to if people were regularly being tested and treated.

SREENIVASAN: Author and HIV scholar Steven Thrasher, thanks so much for joining us.

THRASHER: Thank you so much, Hari.