Launched by Republican President George W. Bush in 2003, the President’s Emergency Plan for AIDS Relief (PEPFAR) has saved an estimated 25 million lives, mostly in Africa. One of the most success global health programs ever, PEPFAR has also enjoyed two decades of bipartisan support. That is, until now.

The fight over abortion rights threatens the HIV program’s future, as Republican lawmakers claim that PEPFAR funding is indirectly supporting abortions, reports The Washington Post. PEPFAR officials and Democrats deny the allegations.

Congress must reauthorize PEPFAR, as it has done every five years since the program’s inception. But this year, it is uncertain whether Congress will reauthorize the program or, if so, for how long (maybe one or two years instead of five).

Reauthorization means the programs are allowed to continue. Congress must also fund the program, through appropriations bills. But for foreign-assistance programs like PEPFAR, Congress usually side-steps this two-part process, explains KFF’s Global Health Policy. Passing the funding bills usually doubles as reauthorizing the programs. PEPFAR’s current provisions are set to expire September 30.

As The New York Times notes, Republicans control the House of Representatives, and GOP extremists are leveraging their power to impose their policy wishes regarding abortion and LGBTQ rights in areas of federal government that have previously enjoyed bipartisan support, such as the military budget.

PEPFAR spans more than 50 countries and is funded at nearly $7 billion each year. On January 28, PEPFAR celebrated 20 years.

“Through PEPFAR, we have saved 25 million lives, and 5.5 million babies have been born HIV-free. Over a million clients have received pre-exposure prophylaxis [PrEP] to prevent HIV infection,” wrote Ambassador John N. Nkengasong, MD, in a statement marking the program’s anniversary. “Also because of PEPFAR,” he added, “we have seen more than a 50% reduction in new HIV infections in women 15 to 24 years of age, and a 65% reduction in new infections among men in the same age range.”

If Congress fails to reauthorize PEPFAR, it won’t mean the end of the program. KFF explains:

“Absent a reauthorization, the PEPFAR program would continue, provided funds are appropriated. There are, however, some requirements that are time-bound and would ‘sunset’ if a reauthorization bill is not passed (Congress could, for example, simply extend the dates of these time-bound provisions in a reauthorization bill) or if Congress does not address them through another legislative vehicle. Specifically, there are seven requirements that would end after FY [fiscal year] 2023, and one that would end after FY 2024, if not addressed. Of these, two relate to how HIV funding is allocated, four specify requirements related to the U.S. contribution to the Global Fund and two address reporting or oversight.”

In a separate PEPFAR funding controversy, LGBTQ activists and human rights advocates are voicing concern that financial aid going to Uganda will support that country’s new law that makes gay sex punishable by life in prison. What’s more “aggravated homosexuality”—including transmitting HIV—is punishable by death in Uganda, according to Reuters. As a result, many LGBTQ people are afraid to seek HIV treatment.

PEPFAR supplied $418 million to Uganda’s HIV treatment budget in the fiscal year 2021–2022, accounting for more than half of the country’s budget for treatment.

But withholding HIV funding to pressure the country to reverse its antigay laws might backfire. Doing so would adversely affect such HIV-related gains as the decline in mother-to-child transmission of the virus.