Looming debate over the reauthorization of PEPFAR has some pro-life advocates raising alarm about the potential for some funding going to abortion, while others say safeguards are in place to prevent such spending.

PEPFAR, the U.S. President's Emergency Plan for AIDS Relief, authorized by Congress and President George W. Bush in 2003, is the U.S. government's global effort to combat HIV/AIDS. The program is the largest global health program devoted to a single disease.

PEPFAR is credited with saving 25 million lives and scaling back the epidemic's spread, and is seen as an example of successful bipartisanship, continuing across each presidential administration since. The program, in part, distributes antiretrovirals in countries where as many as one-third of adults were impacted. PEPFAR's funding has totaled more than $110 billion to date; Congress will consider its reauthorization this year.

But some pro-life groups have raised alarm about what they argue is potential for funds to go to abortions in this year's potential reauthorization.

Rep. Chris Smith, R-N.J., a longtime supporter of PEPFAR, this year expressed concern about reauthorization without adding language prohibiting administrators from funding groups that advocate for abortion access.

Some pro-life and conservative groups have announced plans to score against a vote in favor of PEPFAR's reauthorization in its current form on their congressional scorecards for lawmakers, including Susan B. Anthony Pro-Life America.

In a statement provided to OSV News, Autumn Christensen, SBA vice president of public policy, said the organization "supports efforts to ensure that PEPFAR remains focused on its core mission -- addressing HIV/AIDS."

"As the largest global health program funded by U.S. taxpayers, it has always been a target for organizations who want to divert funds to their agenda of overturning pro-life laws around the world," Christensen said. "Unfortunately, this administration has bowed to the pressures of the international abortion lobby and integrated broader sexual and reproductive services (which includes abortion) into their strategic plans."

Christensen said PEPFAR "has been a wonderful bipartisan policy that helps combat HIV/AIDS around the globe, that's why it is so egregious that the Biden administration is pushing for funding to abortion groups to expand 'reproductive services' that promote and push abortion -- PEPFAR should be solely focused on saving lives not taking them."

The Biden administration is seeking a "clean" reauthorization of the program for five years, with no policy changes, which would have permitted Congress to pass status-quo PEPFAR legislation without contentious debate.

But Christensen said "a 'clean' five-year authorization would give a stamp of approval to the administration's partisan and divisive effort to incorporate abortion into the PEPFAR program."

She said they commend a one-year reauthorization of PEPAR advanced by Rep. Mario Diaz-Balart, R-Fla., that requires a report on the recipients of PEPFAR funds and "directs funds to foreign nongovernmental organizations that do not promote or perform abortion."

However, others have argued that claims PEPFAR would advance abortion overseas are without merit, including the Biden administration, which has denied using PEPFAR for such a purpose.

The legality and availability of abortion varies in recipient nations. According to the Guttmacher Institute, which supports legal abortion, ??an estimated 93% of women of reproductive age in Africa live in countries with what it called "restrictive abortion laws."

In June comments to Politico, Senate Foreign Relations Chair Bob Menendez, D-N.J., who supports legal abortion, said claims the program would fund abortions are a "smear."

"They're taking what was an initiative of George Bush that has been successful across the globe, particularly in Africa, and are now trying to make it a political issue about abortion," he said.

A July 14 letter from Catholic Relief Services and the U.S. Conference of Catholic Bishops to congressional lawmakers argued in favor of PEPFAR's reauthorization while outlining important principles to guide Congress.

"We write to affirm PEPFAR's extraordinary life-saving work to date, and to express our strong, ongoing support for its goals and hope for its robust continuation," the letter said.

Besides outlining their moral objections to condoms, and their refusal to provide them in any programming, the USCCB-CRS letter added the "life-saving work of PEPFAR should never be entangled with the promotion of abortion, a grave evil and the opposite of life-saving care."

Congress, in the midst of its August recess through Labor Day, will likely consider PEPFAR's reauthorization upon its return, as some of the program's provisions are set to expire Sept. 30.

In a July 20 letter to Secretary of State Antony Blinken and U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy Ambassador Dr. John N. Nkengasong, Reps. Abigail Spanberger, D-Va., and Mike Lawler, R-N.Y., led a group of 75 Democrats and Republicans in the U.S. House in reiterating their support for PEPFAR.

"We enthusiastically endorse PEPFAR's reauthorization, which benefits from strong bipartisan support," the letter said. "We also support the Administration's commitment to ending HIV/AIDS as a public health threat by 2030."

The letter drew attention to their concern that in 2021, "approximately 130,000 newborns were infected with HIV in sub-Saharan Africa," many of whom would die in the first years of life with others requiring "a lifetime of care, which is expensive and difficult to execute."

"Unless something genuinely different is done, these women will continue to suffer with, die from, and transmit to their babies AIDS," they said, advocating the revival of a PEPFAR-funded program during the Obama administration that cut maternal mortality by 40% and increased HIV treatment by 71%.

In a statement accompanying that letter, Dr. Jon Fielder, co-founder and chief executive of Africa Mission HealthCare and Mark Gerson, co-founder and board chair, emphasized their support for PEPFAR, while underlining its potential to save mothers and babies.

"Millions of lives have been saved as a result of the remarkable and visionary work of PEPFAR, however, critical gaps remain to achieve HIV/AIDS epidemic control and prevent the vicious cycle of mother-to-child transmission," they said.

"We are heartened by this bipartisan support for mothers with HIV and their babies in Africa," Fielder and Gerson stated. "PEPFAR can effectively design and implement clinical programs that will provide millions of mothers and babies a safe pregnancy and the delivery of a healthy baby."

At a February event in Washington marking the program's 20th anniversary, Bush said the U.S. is a prosperous nation "to whom much has been given, much is expected" -- a reference to Jesus Christ's words in Luke 12:48.

Bush argued the program is both in the moral and national security interests of the U.S., as it saves lives and strengthens diplomatic ties with recipient nations. He said a large-scale loss of life from the AIDS epidemic would have destabilized the African continent, leaving it vulnerable to bad actors, such as al-Qaida.