Nancy Pelosi, the Democratic former Area speaker, and George W. Bush, the Republican former president, don’t agree on a lot. However previous this yr, they joined a high-powered accumulating in Washington — with the Irish rock celebrity Bono on video from Dublin — to mark the twentieth anniversary of The united states’s largest and, arguably, maximum a hit overseas assist program.

Mr. Bush created that program, the President’s Emergency Program for AIDS Reduction, in 2003. Within the 20 years since, PEPFAR, as it’s recognized, has stored 25 million lives and served as a formidable software for comfortable international relations, a logo of The united states’s ethical management on the earth. It has had strange enhance from a bipartisan coalition of liberals and Christian conservatives.

However now PEPFAR is in peril of turning into a sufferer of abortion politics — simply because the State Division is reorganizing to make this system everlasting.

This system is about to run out on the finish of September. However Area Republicans aren’t transferring ahead with a invoice to reauthorize it for any other 5 years, as a result of abortion combatants — led by way of a G.O.P. congressman who has lengthy been a supporter of PEPFAR — are insisting on including abortion-related restrictions.

The stalemate is the most recent instance of ways Republicans are the usage of their majority within the Area of Representatives to impose their conservative perspectives on social coverage all over the government. They’ve targeted specifically on abortion, a yr after the Excellent Court docket overturned Roe v. Wade and, with it, the fitting to felony abortion. Previous this summer season, Area Republicans loaded up the once a year army coverage invoice that has lengthy been bipartisan with provisions to restrict abortion get right of entry to and transgender care.

The struggle over PEPFAR, a $7 billion-a-year program that operates in additional than 50 international locations, is the same, as a result of this is a widely bipartisan program that now seems liable to being sucked right into a partisan struggle over cultural and social problems.

PEPFAR continues to have vast enhance, together with from Consultant Michael McCaul of Texas, the Republican chairman of the Overseas Affairs Committee, which oversees this system and approve the reauthorization regulation. However thus far, Mr. McCaul has now not complex it as a result of the objections of abortion foes, together with his Republican colleague, Consultant Christopher H. Smith of New Jersey, some of the main anti-abortion voices in Congress who additionally helped draft the regulation developing PEPFAR.

Mr. Smith now says he’s going to now not comply with renew this system until it’s matter to the so-called Mexico Town coverage — enacted by way of Republican presidents however lifted by way of Democrats, together with President Biden — that might bar this system from partnering with any group that gives abortion products and services, regardless of the supply of the investment.

That could be a non-starter for Democrats, who’re tough a “blank” five-year reauthorization — one without a added coverage restrictions.

“We’ve executed blank reauthorizations for twenty years,” stated Consultant Barbara Lee, Democratic of California and a major sponsor of PEPFAR.

However there’s a considerable stumbling block: 3 influential out of doors teams that oppose abortion — the Circle of relatives Analysis Council, the Heritage Basis’s political motion arm and Susan B. Anthony Professional-Existence The united states — have sided with Mr. Smith and intend to “ranking” the vote once they assemble their annual scores of contributors of Congress. A vote for renewing PEPFAR with out the anti-abortion language can be counted as a demerit, making it politically poisonous for many Republicans.

The location has alarmed champions of this system. In an electronic mail, Bono referred to as the deadlock “insanity,” and referred to as on Congress to “give protection to the bipartisan dedication to preserving politics out of PEPFAR.”

Mr. McCaul stated he’s “chatting with supporters each outside and inside the federal government, and dealing with my colleagues on each side of the aisle within the Area and the Senate” to get to the bottom of the dispute. He has additionally been texting with Bono, who in flip has been involved with congressional leaders at the topic.

A senior White Area reliable, talking at the situation of anonymity to explain the negotiations, stated on Thursday that the White Area used to be “attractive intently with Congress at senior ranges” in pursuit of a immediately five-year reauthorization.

This system is an vital legacy for Mr. Bush and different Republicans of his generation, together with Invoice Frist, the previous Senate majority chief, and Rick Santorum, a former senator from Pennsylvania.

“I glance again at the issues I did as a member of Congress, and really feel like I used to be ready, because the pro-life warrior in the US Senate, to forge a compromise to get conservatives to enhance this,” Mr. Santorum stated in an interview. “It’s been an ideal factor for our nation, and it’s been an ideal factor for humanity.”

Final week, Mr. Santorum publicly pleaded for a “five-year, blank extension” in an opinion essay within the conservative outlet Newsmax. He stated he meant to make use of Congress’s upcoming August recess to take a look at to forge a compromise.

However in fresh months, Mr. Smith, the New Jersey Republican, and right-wing teams have begun accusing the Biden management of injecting innovative politics into this system.

In past due Would possibly, a Heritage Basis student revealed an essay in The Hill arguing that PEPFAR had change into “increasingly more politicized” and wanted an overhaul. Mr. Smith adopted in early June with “Expensive Colleague” letter announcing that Mr. Biden had “hijacked PEPFAR.”

In an interview, he pointed to new language in a PEPFAR nation and regional operational plan calling for this system to spouse with organizations that recommend for “institutional reforms in legislation and coverage referring to sexual, reproductive and financial rights of girls.” He argued that used to be code for a plan to “combine abortion with H.I.V./AIDS paintings.”

The file additionally says PEPFAR methods will have to “advance human rights and decriminalization for lesbian, homosexual, bisexual, transgender, queer, and intersex (L.G.B.T.Q.I.+) communities.” That didn’t sit down neatly with the Circle of relatives Analysis Council, whose leader lobbyist, Travis Weber, lately referred to as PEPFAR “a large slush fund for abortion and L.G.B.T. advocacy.” In an interview, he stated he stood by way of the ones phrases.

The senior White Area reliable stated that the “intentional focal point on well being fairness is new” and that it got here according to requests from native communities for PEPFAR to “cope with limitations to well being for kids, adolescent ladies and younger ladies, and key populations.” The point out of girls’s rights refers to making sure that adolescent ladies have get right of entry to to colleges, the reliable stated.

The Biden management has added a footnote to the file clarifying that PEPFAR does now not fund abortions, an statement that Mr. Smith referred to as “meaningless.”

There is not any proof that PEPFAR or its overseas companions have used federal tax greenbacks to advertise or carry out abortions; U.S. legislation does now not permit it. However some PEPFAR grantees, similar to Inhabitants Products and services World, a world well being nonprofit founded in Washington, do supply abortion-related products and services with cash from different resources.

“The statement is made by way of critics is that organizations like P.S.I. are operating with U.S. cash and concerned with abortion — and shouldn’t that be unlawful?” stated Karl Hofmann, the gang’s president and leader government. “I assume my resolution is, the ones two information are true, and it’s now not unlawful.”

Ms. Lee, the California Democrat, stated she is operating to “explain this misrepresentation” being made by way of Mr. Smith.

However the potentialities for a five-year extension appear bleak.

“We’re in an excessively precarious position,” stated Shepherd Smith, an evangelical Christian and a co-founder of Childrens AIDS Fund World, a nonprofit. He has arranged different faith-based teams to factor a letter in enhance of reauthorization.

Christopher H. Smith, the New Jersey congressman, has proposed another: He persuaded fellow Republicans to insert language right into a State Division spending invoice that might permit PEPFAR to stay working for a yr and not using a new authorization, however matter to the anti-abortion restrictions. That measure, on the other hand, like most of the spending expenses making their manner during the Republican-led Area, is not going to be applicable to the Democratic-controlled Senate.

And the symbolism of the sort of transfer can be devastating, PEPFAR’s backers say — a sign to different international locations that the US is forsaking its bipartisan dedication to finish the AIDS epidemic by way of 2030, and that Washington is in point of fact damaged. It could even be a setback for world well being; PEPFAR has created an infrastructure of clinics in deficient international locations that offer different products and services, together with Covid-19 checking out and vaccines.

“This isn’t a subject matter that in any respect comes to abortion — it’s about having well being care amenities in international locations to care for pandemic form of demanding situations,” stated Senator Benjamin L. Cardin, Democrat of Maryland. He referred to as PEPFAR’s advent “some of the nice moments in American overseas coverage.”

As the controversy performs out on Capitol Hill, the State Division reliable who oversees PEPFAR, Dr. John N. Nkengasong, is set to get a large promotion. On Tuesday, Secretary of State Antony J. Blinken is predicted to announce the status quo of a brand new Bureau of International Well being Safety and International relations, to be led by way of Dr. Nkengasong. The theory is to combine PEPFAR into the dept’s broader world well being paintings and to transition it out of emergency standing.

Since its inception, this system has invested greater than $100 billion in combating the worldwide AIDS disaster. Impartial analyses by way of Okay.F.F., previously the Kaiser Circle of relatives Basis, have discovered that PEPFAR has helped strengthen maternal and kid well being and is “related to huge, vital declines in mortality” in international locations the place it has operated.

Backers of this system are hoping that Mr. Bush will weigh in. Previous this yr, Emily Bass, an writer and activist, despatched the previous president a signed replica of her e-book, “To Finish a Plague: The united states’s Combat to Defeat AIDS in Africa,” which chronicles the PEPFAR tale.

A couple of weeks in the past, Ms. Bass stated, Mr. Bush despatched a letter thanking her.

“Laura and I will be able to stay invested on this challenge for the remainder of our lives,” he wrote.