Fierce opposition from conservative lawmakers is casting doubt on the future of PEPFAR, the U.S. government’s most successful global-health program, which was set up two decades ago by the George W. Bush administration to address the HIV epidemic. Since 2003, PEPFAR, the President’s Emergency Plan for AIDS Relief, has funded antiretroviral treatment for more than 20 million people across more than 50 countries in its 20-year existence. The project has donated about $110 billion to health projects globally, yet a decision to fund the program’s next five-year cycle has become embroiled in the domestic abortion debate. Authorization for PEPFAR lapsed at the end of September after it failed to get congressional approval. This moves the program to an annual rather than a five-year cycle and cuts requirements that 10 percent of PEPFAR funding go directly to orphans and other children affected by HIV.