Evangelical Aid Orgs Contradict Pro-Life Groups, Deny PEPFAR Needs Guardrails against Abortion

While many pro-life organizations warn the President’s Emergency Plan for AIDS Relief (PEPFAR) needs more guardrails against abortion, some evangelicals who work on the AIDS issue deny the problem exists. Shepherd Smith, co-founder of Children’s AIDS Fund International and one of PEPFAR’s early evangelical advocates, called it “simply false” that PEPFAR dollars fund abortion.

PEPFAR is the largest U.S. program for combatting HIV/AIDS in developing countries. “PEPFAR is hugely complicated and complex in all it does. It’s a massive program. It’s the best program we’ve ever seen run by the government,” Smith told The Washington Stand. “This one is exceptional. They know how many doses of medicine they need in each country. They have a complicated supply chain which USAID has run — and I’ll say, not well, but it functions.”

The program has enjoyed bipartisan support since its creation in 2003, but the Biden State Department in September 2022 indicated it was “Reimagining PEPFAR’s Strategic Direction,” calling for PEPFAR’s HIV programming to integrate “sexual reproductive health, rights, and services” and for greater coordination between PEPFAR and “other U.S. government global health and development programs, including for … sexual and reproductive health and rights … LGBTQI+, and human rights.”

“According to progressives, ‘reproductive health’ necessarily includes abortion. We would be naive to ignore these code words for abortion,” wrote Arielle Del Turco, director of the Center for Religious Liberty at Family Research Council, and Travis Weber, Vice President for Policy and Government Affairs at Family Research Council.

Smith called this a “misunderstanding of terms” of “what ‘reproductive sexual health’ means in PEPFAR, versus what it means to pro-life groups here.” Smith granted that, in the U.S., “it’s pretty much synonymous [with] abortion, especially if the words ‘rights’ is included with that. And I would agree, on the rights part, that it can mean that.” But “within PEPFAR’s thinking and community,” he added, the term “reproductive sexual health” means “dealing with women who are HIV-positive, who often have other STDs. It’s about mother-to-child transmission of HIV.”

Smith complained that PEPFAR critics couldn’t produce any evidence. “There’s been a lot of innuendo, and a lot of suggestions, but I haven’t seen any evidence put forward by anyone of something actually having happened related to abortion.” He added, “I’ve talked to the groups that are questionable. I can’t find evidence that they have done anything. I’ve talked to the government people who oversee the program. … They could find no evidence.”

Smith added that the Helms and Siljander amendments prohibit the use of PEPFAR money to carry out or promote abortions, even without Mexico City protections. In addition, he pointed out that abortion is illegal in “nearly all the countries in Africa” and “nearly all places where PEPFAR operates.” If a large grantee who was not pro-life carried out an abortion with PEPFAR funds, Smith argued, “They would then jeopardize, say, a $20 million award to do, you know, a few thousand dollars of work on abortion. It just doesn’t make sense that they would do that.”

“Opponents of wanting to add pro-life protections to PEPFAR may claim we can’t prove the money is being used to perform abortions,” Weber told The Washington Stand. “True, we can’t prove that. But it’s also not the central point. What matters is that some organizations taking PEPFAR money (over $1.34 billion of it) are rabidly pro-abortion.” He said PEPFAR is “being used as a massive slush fund for abortion and LGBT advocacy.”

The non-government organizations (NGOs) to obtain the most funding through PEPFAR are Family Health International (FHI) 360 ($2.4 billion), Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) ($1.5 billion), and Population Services International (PSI) ($768 million), accounting for more than a quarter of all PEPFAR grants to NGOs, according to a database of PEPFAR funding. All three groups carry out abortion, and EGPAF explicitly tied abortion to their anti-AIDS work in 2021.

These three pro-abortion organizations go beyond treating HIV-positive women and preventing mother-to-child transmission. One of PEPFAR’s six program areas is care, while another is HIV/AIDS prevention, which “ranges from contraceptives to voluntary circumcision programs to reproductive health education.” Within the prevention category are subdivisions for preventing mother-to-child transmission, male circumcision, blood safety, and injection safety, abstinence education programs, drug use programs, and “other sexual prevention.” Thirty percent of PEPFAR’s “prevention” dollars — a total of $3 billion — are spent on “other sexual prevention,” with the top allocations going to FHI 360 ($284 million) and PSI ($217 million), with EGPAF coming in ninth ($35 million).

“It doesn’t matter that the PEPFAR money itself may or may not be used to promote or perform abortions,” Weber continued. “It is being used to further, advance, and give life support to abortions and abortion promotion. That is unacceptable for a program whose very purpose is to stop the scourge of AIDS in Africa.”

By contrast, Smith cares more that the government program includes faith-based organizations than whether it excludes abortion organizations. A major virtue of PEPFAR is that it allowed “the faith community to be involved in government contracting. Prior to that time, USAID put poison pills into contracts that excluded faith groups,” he explained. “USAID is easily the most pro-abortion corner of the government.” Smith said he was concerned that, if pro-lifers succeed in forcing changes to PEPFAR now, “then the Democrats come in and say, we’ll take away the conscience clause. You take away the conscience clause, and you kill the program, because you take the faith community out of it.”

Smith is also “worried about the reputation of the pro-life community.” He referenced a September 5 New York Times op-ed titled, “It’s Not Pro-Life to Oppose a Program That Has Saved 25 Million Lives,” by a Catholic priest. “In that, [pro-lifers are] defined as an anti-abortion person,” he noted. “We are putting in jeopardy the lives of all those people. … I really fear the pro-life community is going to look really bad if we don’t get a clean, five-year reauthorization.”

PEPFAR’s five-year authorization is scheduled to expire at the end of the month, and pro-lifers have urged Congress to either apply the Mexico City Policy to PEPFAR funds or reauthorize it for one year only.

In addition to the abortion concerns, social conservatives have also warned that PEPFAR funds comprehensive sexuality education through the “DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe)” Initiative. PEPFAR invested over $800 million through DREAMS from 2015-2019. “Everyone is pointing to abortion, but we should also be looking at the comprehensive sexuality education,” Keystone Policy founder and CEO Bethany Kozma, who served as deputy chief of staff for the U.S. Agency for International Development (USAID) during the Trump administration, told The Washington Stand. Kozma directed TWS to a USAID-funded comprehensive sexuality education curriculum in South Africa, available on USAID’s website.

“With a sexually transmitted disease it’s difficult not to talk about sex,” Smith countered. “Yes, PEPFAR does explain how HIV/AIDS is spread, but isn’t the messenger of explicit sexual promotion as alleged.” He said the true cause of alarm has been “the spread of the internet — and to a lesser extent cell phones — bringing messages from Hollywood and very radical groups and their ideas.”

According to the USAID-funded Scripted Lesson Plans Kozma referenced, South African 10-year-olds are introduced to sexuality-related concepts, including the transmission of HIV. Twelve-year-olds are taught about the “care, treatment, and support” for HIV and AIDS. Thirteen and 14-year-olds are taught to make decisions about sex and know their limits. Fifteen-year-olds are taught how to use condoms. Lessons on gender exploration are sprinkled throughout.

Kozma criticized Smith by name. “Shepherd Smith has gotten so much money that he won’t see abortion,” she said. According to Smith, his organization, Children’s AIDS Fund International, does not have any current PEPFAR grants. But he did say, “we’ve been grantees on many occasions, through many parts of the government, in the past,” right after he said, “it’s the best program we’ve ever seen run by the government.”

However, other evangelical organizations defending PEPFAR in its current form are receiving funding through the program. Myal Greene, president and CEO of World Relief, defended the program in a September 2 op-ed in The Hill. World Relief has received $18.7 million in PEPFAR grants since 2005.

“Even among PEPFAR grantees that may not share the same convictions, we’ve never seen any hint that any funds are being unlawfully used to promote abortion,” said Greene. “In World Relief’s work, it would be unthinkable for us to ever engage in promoting abortion. … It would also be illegal — under U.S. law and under the laws of most of the sovereign African nations where World Relief operates.”

“From a Christian perspective, this program represents an unwavering commitment to the sanctity of life, responsible stewardship, collaboration, justice and empowerment,” Greene continued. “Evangelical Christians played a critical role in originally passing PEPFAR,” she insisted, and “PEPFAR’s leadership understands that faith-based partners have been ‘at the center of PEPFAR’s efforts since the program’s inception.’”

Other evangelical organizations with major PEPFAR funding include World Vision and Hope Worldwide. Hope Worldwide received $65.3 million in PEPFAR grants since 2007, and it did not respond to a request for comment. World Vision has received $171.2 million in PEPFAR grants since 2006. It participates in the DREAMS initiative, as well as the InterAction coalition, an NGO lobbying organization dominated by far-Left ideology. World Vision declined to comment.

One faith-based organization to express caution over PEPFAR’s direction is Samaritan’s Purse. Smith accidentally included Samaritan’s Purse as a signatory on a letter supporting a clean PEPFAR reauthorization but removed the organization when they brought it to his attention. Samaritan’s Purse received $13.8 million in PEPFAR grants since 2007, but nothing since 2014.

“Samaritan’s Purse has been a supporter of PEPFAR in the past, but we have not taken a position on the reauthorization of the program this year because it has become much more complicated with how funds are being allocated,” Franklin Graham, president and CEO of Samaritan’s Purse, told The Washington Stand. “I hope PEPFAR is not hijacked by people with a different agenda. The PEPFAR of the past had a singular focus — saving the lives of people with HIV — and that I support.”

Whatever position evangelicals have taken in the current debate over PEPFAR funding, they would all largely agree with Graham on two points: that PEPFAR was a positive program as it was created, and that it should not fund abortion.

“PEPFAR funds should not be used to promote the Biden administration’s radical social policies on abortion and LGBT ideology overseas,” Del Turco wrote in a new publication, “Stop the Co-opting of PEPFAR.” “Congress should closely examine the program and recalibrate it to its intended purpose: eradicating the scourge of HIV/AIDS in the developing world. Abortion and gender ideology do not cure any diseases and have no place in America’s fight against HIV/AIDS.”