Now that Roe v. Wade is history, a coalition of anti-abortion groups are eagerly returning to a longstanding fight: to require any U.S. funding for public health further their goals of prohibiting abortion. These groups want Republicans to block re-authorization of the President’s Emergency Plan for AIDS Relief (PEPFAR). In a letter to Republican leadership in the House and Senate this past fall, they alleged that the Biden administration was using the two-decades-old HIV/AIDS initiative to help “abortion-promoting NGOs.” They demanded that Republicans “make sure funding goes to ending HIV/AIDS, not promoting abortion.”
This letter was signed by twelve groups, including The Heritage Foundation, Students for Life America, the Family Research Council, Catholic Vote, March for Life, and Susan B. Anthony Pro-Life America. Of course, it failed to include the signature of one prominent partner shared by most of them in their ongoing crusade against reproductive freedom: Leonard Leo, co-chairman of the Federalist Society, whose dark money campaign to influence the judiciary also helped fund groups behind anti-abortion cases, including Dobbs and the upcoming Supreme Court case on medication abortion. Leo not only funded the group who crafted and won the Dobbs case, Alliance Defending Freedom, but Leo also steered three of the judges who would decide the case onto the court. Since 2020, Leo has granted eight of the anti-abortion groups that signed the PEPFAR blockade letter more than $10 million. This attempt to hold billions of dollars in HIV/AIDS funding hostage over any support for abortion should make one thing clear: that Leo’s extensive anti-abortion ambitions reach outside the courts, into the legislative branch.
While Leo is perhaps most known for the outsize, corrosive influence he has on the Supreme Court, it seems like he is redeploying his anti-abortion project. “It’s an outgrowth of his previous approach,” said Caroline Ciccone, president of the watchdog group Accountable.US. “He’s accomplished what he needed, what he wanted in court, and now he’s turning to new places.” Leo’s purse is nearly bottomless, after scoring a $1.65 billion gift from a major conservative donor. “He has such a huge sum of money,” Ciccone added. “He can do anything.” We reached out to Leonard Leo for comment on this story. He did not reply before publication
Launched under the Bush administration in 2003, PEPFAR has moved more than $100 billion to 55 countries, according to USAID. The majority of PEPFAR funds are earmarked for treatment—in fiscal year 2022, it reportedly provided 7 million people with HIV treatment (globally, in 2022, it’s estimated 39 million people were living with HIV). It also funds some socio-economic programs, like legal support, peer support, and HIV stigma prevention. While PEPFAR as an initiative could still exist without reauthorization, the State Department has said that they cannot currently allocate and move funding; if this is not rectified, they said in a statement to The Washington Post in October, “PEPFAR’s lifesaving work and gains will be threatened.” If PEPFAR is reauthorized with the new anti-abortion restrictions, this could also compromise its work. While PEPFAR is already banned from funding abortion (a fact these groups are doubtless aware of), their proposal to bar PEPFAR grantees from “promoting” abortion—which could be interpreted as even discussing abortion as an option—even if they use non-PEPFAR funds, could severely limit the medical care those who would otherwise benefit from PEPFAR could receive.
Leo’s contributions to eight of the twelve groups trying to block PEPFAR were made through a number of 501(c)3 nonprofit organizations that can obscure his role, as tax filings reviewed by The New Republic show. These include donor advised funds and dark money groups, as identified by Accountable.US, who shared tax records and their findings with us. Leo may have personally benefitted from the way he can move money in these networks. He is now the subject of a tax investigation by the Washington D.C. attorney general for “potentially misusing nonprofit tax laws for self-enrichment,” Politico has reported. Leo is not cooperating. Leo has also been evasive when asked about his dark money arrangements. “It’s not to hide in the shadows,” he said in a podcast interview in July 2023. “It’s because we want ideas judged by their own moral and intellectual force.”
Central to the story of PEPFAR is the idea that fighting AIDS defies partisanship and has been broadly supported—after all, Bush launched it!—from the beginning. But like many things involving HIV/AIDS, the program has also been a vehicle for Christian right groups to use a viral pandemic to advance their own political goals. These groups have successfully advocated for billions of PEPFAR dollars to be earmarked for abstinence-until-marriage prevention and education, leaving condoms and anyone who did not want to or legally could not get married (like queer couples) out in the cold, until this was removed in 2008. The Christian right was also instrumental (though not alone) in requiring PEPFAR recipients affirm that they oppose prostitution as a condition of funding, a policy the Supreme Court upheld in part in 2012, and which remains in PEPFAR to this day.
So it is not much of a surprise that the Christian right has come again for PEPFAR. But to block the entire program from being reauthorized, putting funds in jeopardy for programs around the globe—prompting the former President Bush to wade in and plead with Congress to reauthorize PEPFAR—seems even more brazen than earlier efforts. And Leonard Leo is partly responsible for that.
Dobbs, it appears, changed the calculus. The narrative these groups are using to obstruct AIDS funding hinges on their claim that now that Roe has been reversed, the Biden administration is trying to smuggle funds for abortion into HIV/AIDS funding. In their September 2023 letter to Congressional leadership, the anti-abortion groups confidently stated that Biden’s State Department was using PEPFAR for this, “in spite of the fact that there is no constitutional or statutory ‘right to abortion’ in U.S. law, and in fact, nearly half of all American States outlaw elective abortion from early stages of gestation.” This encapsulated the broader accusations leveled at PEPFAR under Biden that debuted in a report from Heritage in May 2023. PEPFAR, the report alleged, was being used to promote a “domestic radical social agenda overseas,” including “social priorities like abortion and promotion of LGBTI issues.” Somewhat conspiratorially, the report continues, “On the Left, ‘sexual and reproductive rights’ and ‘reproductive health services’ are code for abortion.” This isn’t strictly true; abortion is but one component of sexual and reproductive health and rights. But abortion is one such component, and an important one, and one which anti-abortion groups know full well that PEPFAR already excludes. Emails to The Heritage Foundation and the Family Research Council for comment on this story went unanswered.
U.S. law already stipulates that PEPFAR funds, like foreign aid in general, cannot be spent on providing abortion. As reiterated in its most recent five-year strategy document, “PEPFAR does not fund abortions, consistent with longstanding legal restrictions on the use of foreign assistance funding related to abortion.” Pointing out actual PEPFAR policy and practice, of course, will have little effect on conservative groups’ rhetoric, in part because what these groups are concerned with is broader than abortion: Their concern is controlling our reproductive and sexual health and freedom. And they’re willing to hold up funding for countering a deadly virus to pursue this obsessive quest for control. Talking points on blocking PEPFAR from Family Research Council put it bluntly: “PEPFAR should not be a major slush fund for the Biden administration’s radical social policies on abortion, sexual orientation, and gender ideology overseas.” Meanwhile, Leo’s network, a “slush fund” if there ever was one, tries to stay behind the scenes.
These groups that he funds, who are now targeting PEPFAR, share more than an anti-abortion platform. They serve important functions on the Christian right more broadly. Some are directly involved in implementing something called Project 2025, a plan to remake the next presidential administration on day one to align with Christian conservative goals—a plan which Leo is also backing. The leadership of many of these groups, as documents shared by Accountable.US show, are members of the secretive Council for National Policy, including the presidents of the Americans United for Life, Family Research Council, Students for Life, and Susan B. Anthony List. (Portions of CNP membership lists have been previously published by The New Republic and Documented.) Leo, too, is a CNP member. House Speaker Mike Johnson is a CNP member. His recent “ascent to Speaker of the House is hardly good news for PEPFAR,” wrote J. Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies, in November. “Indeed, it is a thunderclap.”
The PEPFAR battle is one piece of a broader picture in 2024: the prospect that Christian nationalism might prevail. For these groups, to control our sexuality and our genders, our health and our rights, is a fundamental element of gaining total control. We may not typically think of fighting for AIDS funding as part of the fight against Christian nationalism, but this effort shows how it absolutely can be. Some of PEPFAR’s defenders hope to make progress through “dialogue,” to “lead with facts and not misinformation and disinformation,” as Ambassador-At Large John Nkengasong, U.S. Global AIDS Coordinator, said at a recent event. But correcting anti-abortion groups’ lies about PEPFAR and abortion can only go so far in the real fight here. And that’s not nearly far enough.
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