PEPFAR: From AIDS Relief to Leftwing Funding Apparatus

August 11, 2025 2 min read Download Report

Max Primorac

Senior Research Fellow, Margaret Thatcher Center for Freedom

Max is a Senior Research Fellow in the Margaret Thatcher Center for Freedom at The Heritage Foundation.

Summary

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) was established by President George W. Bush in 2003 to respond to the AIDS crisis in Africa. Since then, the program has spent $125 billion and morphed into a leftwing foreign aid entitlement that promotes abortion and gender ideology and only employs progressives. U.S. foreign aid should align with U.S. interests and values. On July 23, the House Appropriations Committee passed the FY 2026 National Security and State Department appropriations bill with $7 billion for PEPFAR. This bill upends the opportunity to bypass woke and expensive U.N. agencies, international NGOs, and contractors and to partner directly with local church-run hospitals. Congress should lower PEPFAR funding to the level requested by the Trump Administration.

Key Takeaways

Today’s PEPFAR represents a direct threat to President Trump’s agenda to defund the Left.

According to Federal Election data, 98 percent of total political contributions from the PEPFAR industry finance progressive political campaigns.

Congress should lower PEPFAR funding to the level requested by the Trump Administration.

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THE ISSUE

President George W. Bush established the President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003 to respond to the AIDS crisis in Africa. Since then, PEPFAR has spent $125 billion and morphed into a leftwing foreign aid entitlement that promotes abortion and gender ideology and only employs progressives. On July 23, the House Appropriations Committee passed the fiscal year (FY) 2026 National Security, Department of State, and Related Programs Appropriations Act with $9.5 billion in global health funding—most of which ($7 billion) goes to PEPFAR.

This amount represents a paltry 5 percent cut from last year—and a 151 percent increase over that requested by President Donald Trump at a time of crushing national debt. PEPFAR is now a permanent global welfare program vehicle for the Left’s global agenda.

Despite controlling the White House and Congress, conservatives were defeated by big-monied pro-abortion supporters, such as the Gates Foundation, through a multimillion-dollar campaign to pressure Congress to continue taxpayer financing of PEPFAR’s political agenda in perpetuity. PEPFAR represents a direct threat to President Trump’s agenda to defund the Left.

WASTE AND ABUSE

According to the U.S. House Foreign Affairs Committee, billions of dollars in overhead and program charges never leave Washington, DC.
According to Federal Election data, 98 percent of total political contributions from the PEPFAR industry finance progressive political campaigns.
A cartel of nongovernmental organizations (NGOs), contractors, U.N. agencies, foundations, universities, churches, and pharmaceutical companies, all captured by the Left, use scare tactics and lies to press Congress to keep the gravy train running.
The program is rife with waste, fraud, and abuse. Recently, the U.S. Ambassador to Zambia cut $50 million in AIDS relief due to mass theft of U.S. medicines by state officials. In 2020, even the U.S. Agency for International Development took note of massive corruption and stopped working with Kenya’s state agency for medicines.
The U.S. Centers for Disease Control and Prevention exposed how PEPFAR financed abortions in Mozambique, violating U.S. laws. Two years ago, 131 parliamentarians and religious, health, and law leaders from 13 countries implored Congress to stop supporting anti-life PEPFAR programs.
Top PEPFAR recipients have forged military ties with Communist China and 19 of the top 20 U.S. foreign aid recipients are members of China’s Belt and Road Initiative, disproving the bill’s claim that “global health programming are [sic] a fundamental pillar of America’s national security agenda.”
Host countries must copay more of PEPFAR’s costs, but absent deeper cuts these countries have no incentives to take financial ownership, furthering aid dependence, socialist policies, and corruption.
Multilateral entities funded by PEPFAR are tied to the pro-abortion Gates Foundation, World Economic Forum, and transgender advocates Wellcome Trust and Global Health Council.

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CONCLUSION

U.S. foreign aid must align with U.S. interests and values. Bypassing woke and expensive U.N. agencies, international NGOs, and contractors, and partnering directly with local church-run hospitals, will achieve better results and less waste of taxpayer money. Congress should work with the Trump Administration to make deep cuts to PEPFAR’s bloated budget, prioritize funding of local churches over current international partners, and require beneficiary countries to take fuller financial responsibility for these programs.