Moment of truth It’s been a crowning achievement of bipartisan compassion that has saved millions of lives. It’s also on life support. PEPFAR used to enjoy regular five-year reauthorizations in the U.S. Congress, but last year it got caught up in America’s culture wars over abortion <https://t.devex.com/dc/kyXVoDpAY__Vu56MNr4POjBOuIcNhYLP9ESYBIvEGJgLwD4GJi7k1tMX80I3zK2svhj4KDSB-0J29insq7_ARlA2ulVvBMLdBjP60Kj0v_u9TgHcetpiykdTsaXe3CnD7KHcVExBkgKiiqDIoJcB1qB5bapxATWA63IUODRAywSL8ivRc-DDJp2Bh63XEzKsbIMQVjlXp-PJm_SerOlfzwtjHrTuVjCPd-zzg-x26n5XLS5hjnvEqjfJax4zj5kC7d9LnuRR0Yuo-Xst7zAfDw==/Njg1LUtCTC03NjUAAAGZa_MevBu1mmicFx6YgzSaa5i8TBSmH5e9vfFUwbZWq16kSObdQqgLMtDyACEOwlj0Tc9MVZs=>. It managed to eke out a one-year extension <https://t.devex.com/dc/kyXVoDpAY__Vu56MNr4POsuCyl_Q4myN5F7dZl-G1-gsd6jfb-bMa3F7ptqNRVSylpO0W7H42wvNHo_DPyzKDF0oWeA6a0_9TiRkfooSq7_0Ke_2wX9sGzfq_WPH_Oz_4My7ZhHA2PS6YNyQtrciwYVpwd79vLpkqTcRDGc5R_biYX4dcR4FLZwccLg65ppLAL1Y5pE59FKoAZPwiXWztlnXz8qgxDI_pbn_Gcy-g-HMwD3GjncvbpiVYUqzLRC7/Njg1LUtCTC03NjUAAAGZa_MevBu1mmicFx6YgzSaa5i8TBSmH5e9vfFUwbZWq16kSObdQqgLMtDyACEOwlj0Tc9MVZs=> , *which is all but certain to expire today*. But because the program is written into federal law, “*actual permission for the program to exist doesn’t expire*,” even if PEPFAR’s authorization does, Katie Coester of the Elizabeth Glaser Pediatric AIDS Foundation <https://t.devex.com/Njg1LUtCTC03NjUAAAGZa_MevLGHIkJScSMEQHvdGGuGkV7MZlBCwftAjAWjK7ruo-RaKuyIN0jKz6JBm8hmVRQgDpg=> tells Devex contributing reporter Andrew Green. “As long as there is funding appropriated for the program, *it can technically and legally continue*,” adds Jennifer Kates of KFF <https://t.devex.com/Njg1LUtCTC03NjUAAAGZa_MevC0kAPqFLmVv5aOPBEVa6gDf0H_FGGCbR-iPXSqrK3PEHiOIqnIM751Rz6ck7TCfl-c=> . But take note of that word: technically. USAID administered the majority of PEPFAR <https://t.devex.com/dc/kyXVoDpAY__Vu56MNr4POhrIzr9qjzxt8YhzO6sAn82CFZ-uNWXxkZ_xXzBMAlgypWna1wz8prO1DoY8VtsQCiQkEmaYAbgkkZG6riwp2priMPdJUXD_BQukuINkQo0G7xpG_-eQVvugBhVrf5hdq8d9u-lLgW88qVIbAPmISXljGUo5-dsZa6YrIZnczNFZMn0rvfovn_YzciUUANfpaSu9NXJNbVb-tYlwpUgZ3lmpR-qoofJmhebxLfmRAN24/Njg1LUtCTC03NjUAAAGZa_MevBu1mmicFx6YgzSaa5i8TBSmH5e9vfFUwbZWq16kSObdQqgLMtDyACEOwlj0Tc9MVZs=>. After the agency’s dismantling, lifesaving programs — specifically those such as PEPFAR <https://t.devex.com/Njg1LUtCTC03NjUAAAGZa_MevEbqWomZ4iCm4zF4DfyRKeR2n8jsYH0G6iFvZT-05yvD0jw1Ou7ukcfrwOhPyKSkZ88=> — were meant to be exempted, but the process has been riddled with problems <https://t.devex.com/dc/kyXVoDpAY__Vu56MNr4POrHUo-5KRfbBK_1WFNkKZUKn6Qk8KbKq7oNulzGwVxfCP-hu-p2unUWtuaQdSRL6Cj4hISq4VBOawKnO1pKEusr0MOwrBDy5Qs_-b8dywR6N7a5S42lNs2rFCDCUoUv30lUTwen2yWTeaXORpolTsqmEOrsdpU6WFnf9ncJ4Pg5aXJrokRgSf6Yqyqh1W6nyrdPDk249UGSr7ytoD5I9WF1ngA5JHH156O--QxGtTBTstbyqBkLmrVttbPBusJaCww==/Njg1LUtCTC03NjUAAAGZa_MevBu1mmicFx6YgzSaa5i8TBSmH5e9vfFUwbZWq16kSObdQqgLMtDyACEOwlj0Tc9MVZs=>, from patchy payments to ongoing bewilderment over which services can continue. For example, some treatments have been granted waivers, but contracts for the transportation of medicines and supplies, such as HIV tests, were canceled, hobbling the effectiveness of treatments. In Uganda <https://t.devex.com/dc/kyXVoDpAY__Vu56MNr4POiteFOFayLh74apeWz_sVMEa_ec0md0cpI2h_peU-IFIHWAzYNCcjRNsIao6T1g1uCj_Mwo6blQshlF1E0RTK3z4kZAGKMhinJ_F71zpB3WE9MN_zK0ZFziRBRxwx9kGusYo2FoaGEe_-_frh1WRREmkafPI1ZjiiA5oaJuJZyECc5UnGmA2j0egWoPPyH-__dDR-RXyQ1l0cDJ8TrWFWUgYqFA49osz5aazv-N8jF2OhMsKwqNpbEygEcgNTCWjzQ==/Njg1LUtCTC03NjUAAAGZa_MevBu1mmicFx6YgzSaa5i8TBSmH5e9vfFUwbZWq16kSObdQqgLMtDyACEOwlj0Tc9MVZs=>, Enid Kyomuhendo was due for a refill of the antiretroviral drugs that suppress her HIV infection just days after U.S. President Donald Trump’s stop-work order went into effect. The clinic where she gets the treatment was closed. “I got so worried,” she tells Andrew. “I started taking alcohol. I was thinking that anytime I am going to die. It became this life of hopelessness.” Two months later, she got her refill but now worries she is resistant to the ARVs — and the test to determine if she is resistant is unavailable. “The health workers just tell me to take the medicine because they don’t know what is going to happen next,” she says. *Read:* Why PEPFAR has bigger problems than reauthorization <https://t.devex.com/dc/kyXVoDpAY__Vu56MNr4POhrIzr9qjzxt8YhzO6sAn82CFZ-uNWXxkZ_xXzBMAlgypWna1wz8prO1DoY8VtsQCiQkEmaYAbgkkZG6riwp2priMPdJUXD_BQukuINkQo0G7xpG_-eQVvugBhVrf5hdq8d9u-lLgW88qVIbAPmISXljGUo5-dsZa6YrIZnczNFZMn0rvfovn_YzciUUANfpaSu9NXJNbVb-tYlwpUgZ3lmRsWau-O1WN06hVuyqAndH/Njg1LUtCTC03NjUAAAGZa_MevBu1mmicFx6YgzSaa5i8TBSmH5e9vfFUwbZWq16kSObdQqgLMtDyACEOwlj0Tc9MVZs=>