BREAKING: Some Republicans are against the full five-year extension of PEPFAR, which is being demanded by activists who are now occupying Speaker McCarthy’s office.

BREAKING: Activists are occupying @SpeakerMcCarthy’s office demanding a full 5 year reauthorization of PEPFAR, which some Rs are opposing. Background: https://t.co/nQVnCxPDE0 pic.twitter.com/wCZx4Z6wzu

— Alice Miranda Ollstein (@AliceOllstein) September 11, 2023

The legislation governing the President’s Emergency Plan for AIDS Relief will expire on October 1.

Congress is likely to miss the September 30 deadline for reauthorizing the law governing the United States’ global HIV/AIDS relief operations.

The funding for the program would only be available if Congress maintains federal funding, which is becoming less likely as members with competing demands return this week. However, neither party’s legislators see a clear path to reinstate the law before the end of the year. The impasse threatens to transform an initiative that has been credited with saving 25 million lives into an annual political battle, making it more difficult for organizations fighting HIV and AIDS to hire staff or launch long-term projects, despite the fact that the program would continue to sputter.

Rep. Barbara Lee (D-Calif.), a coauthor of the law that established the President’s Emergency Plan for AIDS Relief during the George W. Bush administration, stated, “For 20 years, we’ve passed bipartisan, clean reauthorizations to keep this program running, and this September, we’re at risk of it expiring.”

In addition, she is the leading Democrat on the Appropriations committee, which determines the budget for the program. When the House reconvenes in mid-September, she plans to initiate a massive lobbying campaign aimed at members elected since PEPFAR’s 2003 inception.

The Biden administration, PEPFAR’s administrators, and outside experts vehemently refute conservative campaigners’ and GOP members of the House’s claims that a portion of the organization’s nearly $7 billion annual funding goes to abortion providers.

Leader of the House’s global health subcommittee supervising PEPFAR, Rep. Chris Smith (R-N.J.), is spearheading the opposition to extending the program until the anti-abortion provisions that the Biden administration removed in 2021 are put back in place. These restrictions would prevent organizations receiving PEPFAR funding from discussing or providing abortions using funds from other sources.

Smith told POLITICO that he worked with Cindy Hyde-Smith (R-Miss.) and other conservatives on Capitol Hill during the August recess to persuade other Republicans in both chambers. According to him, two of their arguments resonated with members. The first is that PEPFAR will continue to receive funding even if the program’s governing legislation expires, and the second is that the Biden administration has “hijacked” the initiative to promote abortion access overseas.

“That’s the gee-whiz moment that’s happening when I have conversations with people who do believe in the sanctity of life,” Smith said. “I’m encouraged that within two or three minutes of a conversation people would say, ‘That’s not what we signed up for. We signed up to go after HIV and AIDS aggressively and effectively, not to have a diversion of priority to abortion on demand.’”

A larger GOP effort to drag more federal programs into the abortion wars coincides with the debate over the historic program aimed at combating AIDS and HIV, the virus that causes it, in the impoverished countries. For instance, House Republicans have inserted anti-abortion language into nearly every aspect of the appropriations process, threatening to provoke an impasse between the Senate and the White House that would lead to a government closure. In addition, Senator Tommy Tuberville (R-Alabama) has been blocking senior military promotions for months due to the Pentagon’s new policy of compensating service members who travel out of state to obtain abortions and other reproductive treatments.

A spokesman for Sen. Jim Risch (R-Idaho), the ranking Republican on the Foreign Relations Committee, which oversees PEPFAR, told POLITICO that it is “unlikely” that Congress will renew PEPFAR before September 30 due to “ongoing confusion” among senators regarding the program’s relationship with abortion. The spokesman cited a number of clauses that could be eliminated as a consequence, including one requiring at least 10 percent of program proceeds to be allocated to AIDS orphan children.

Organizations that receive PEPFAR funding for initiatives in Africa, Asia, and the Caribbean warn that if Congress does nothing, the program will be vulnerable to the tumultuous budget battles on Capitol Hill, send the message that the United States is no longer committed to fighting HIV and AIDS, lose influence in areas where it competes with China and Russia, and have “human consequences” on the ground. According to a UNAIDS survey, 39 million people worldwide are HIV-positive, and 1,3 million new cases were reported last year.

“Taking the foot off the gas at this point is so incredibly ill-advised,” said Asia Russell, the executive director of the Health Global Access Project. “The Biden administration got elected asserting that it would be the administration to put the global HIV response back on track to defeat HIV as a public health threat by 2030. And this would completely derail and break that political commitment.”

National Security Council spokesperson Adrienne Watson stated in an email that the administration will continue to work with both parties to “maintain the bipartisan legacy” and authorize a five-year PEPFAR extension before the current authorization expires at the end of September.

Supporters of the program, such as Senate Chair of Foreign Relations Bob Menendez (D-N.J.), told POLITICO that they aim to achieve this through a vote on the program alone.

“Based on my conversations with some Republicans on the committee, they would be in support of moving PEPFAR forward,” he said in late July. “And I think if it was put up for a vote, it would have broad bipartisan support.”

Nevertheless, a number of Hill staffers and outside organizations have stated that they expect this effort to fail and that the program’s best chance is to ride along with an expected omnibus spending bill in December, which would allow Republicans to vote in favor of it as part of a larger package rather than on its own. Given the impasse over abortion rights, it remains uncertain whether an omnibus bill will pass.