TRANSCRIPT:
Two decades ago, during his 2003 State of the Union address, Republican president George W Bush announced a unique funding program.
"To meet a severe and urgent crisis abroad, tonight I propose the emergency plan for AIDS relief. This comprehensive plan will prevent seven million new AIDS infections, treat at least two million people with life-extending drugs, and provide humane care for millions of people suffering with AIDS."
That program was to become known as the President’s Emergency Plan for AIDS Relief, or PEPFAR.
PEPFAR partners with non-profit groups to provide HIV/AIDS medication to millions around the world, cares for children orphaned by AIDS, and provides job training for people at risk.
Almost 20 years on, the head of PEPFAR, Dr John Nkengasong, says it has saved countless lives in 55 countries from Ukraine to Brazil and Indonesia.
"See where we are today. More than 20 million people are receiving life-saving antiretroviral treatment in the PEPFAR program. It has saved over 25 million lives."
But there's now concern that a small group of Republican politicians are endangering the stability of the program, with the funding coming for renewal this September.
One of the key figures in the group is Chris Smith.
Traditionally a staunch supporter of PEPFAR, Smith is now the chair of the House Foreign Affairs subcommittee, which has jurisdiction over the program.
He has told the Washington Watch television show he won't move forward with reauthorisation of PEPFAR's funding unless it bars non-governmental organisations from using any funding to provide or promote abortion services.
"You know, there was a consensus - right, left, middle - that providing lifesaving medicines and interventions to prevent AIDS in the first place is a very noble goal and it needs to be done. That said, what Biden has done, he has now said that abortion promotion and performance is integrated with all of our HIV/AIDS work overseas."
PEPFAR's supporters say that under existing U.S. law, partners are already prohibited from using its funding for terminations.
hey also point to many partners and recipients being situated in largely conservative countries, who don’t support abortion either because of religious beliefs.
Regardless, the idea that the program reliant on the steady supply of HIV drugs could be subject to political winds is a cause for alarm for Dr Nkengasong.
"It will be sending a message that the fight against HIV/AIDS may end prematurely. We may be sending a message also to our competitors out there that we are withdrawing our support for such an important initiative, and maybe sending a message to the patients that we are not committed to their living a normal life."
It's the impact on children in Africa that has advocates perhaps most worried.
These children are playing in an orphanage in Nairobi.
The graves at the edge of the property tell a story of despair, with the rough planks in the earth painted with the names of children - most of whom died in the 1990s, before the HIV drugs arrived.
Researchers writing in defence of the program in The Lancet medical journal last month say the number of children in sub-Saharan Africa newly orphaned by AIDS reached a peak of 1.6 million in 2004, the year that PEPFAR began its rollout.
36 year old Bernard Mwololo grew up in the Nyumbani Children's Home in the same city, after his parents died of AIDS.
He says he doesn't want to see a return to the days of his childhood - and views funding of HIV medicine and care as too important to be left to local authorities alone.
"You know, some days - it's so crazy when you hear people saying that these HIV drugs should be bought by the local government. I am telling you they can't manage it."
More recent official numbers paint a picture of a happier, more hopeful situation.
With the help of PEPFAR, the number of new orphans had dropped to 382,000 by 2021, with deaths of infants and young children from AIDS in the region dropping by 80 percent.
In Kenya, there are still some 1.4 million children and adults living with HIV - and more than 1 million have received free HIV drugs because of PEPFAR.
The granddaughter of David Shitika, a pastor, is one of them.
He is hoping the threat to PEPFAR will fade.
"It has helped us, mostly my child who is Hellen, and Idah who is my granddaughter. If it was not for that, I would not have them now. So I would tell someone sitting somewhere that we still need that help."
