PEPFAR for the Win!

By: Ranier Simons, ADAP Blog Guest Contributor

What happens when a country realizes the importance of global collaboration in the fight against HIV and AIDS? PEPFAR happens. PEPFAR is the acronym for President’s Emergency Plan for AIDS Relief. This year marks the 20th anniversary of the initiative, the largest commitment ever made by a country targeted at fighting a single disease. The George W. Bush Administration brought PEPFAR into existence via H.R. 1298, the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003.[1] PEPFAR was initially a five-year plan with Congress appropriating $15 billion to combat the HIV/AIDS epidemic globally.[2] Since its inception and three reauthorizations, the U.S. federal government has invested over $110 billion in PEPFAR.[3] 

Photo Source: HIV.gov

H.R 1298 created PEPFAR, defined its structure and funding, and created a new position of U.S. Global AIDS Coordinator at the Department of State, with the rank of Ambassador.[4] The legislation defines the duties of the Coordinator as to: “(1) operate internationally to carry out prevention, care, treatment, support, capacity development, and other activities for combating HIV/AIDS; and (2) provide grants to, and enter into contracts with, nongovernmental organizations, including faith-based and community-based organizations, to carry out such activities.”[1] PEPFAR funding also includes contributions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Significant PEPFAR endeavors include expanding access to HIV treatment and prevention, strengthening health systems, and providing services to children with HIV/AIDS. Many of the children are vulnerable and orphaned. The initial motivation behind PEPFAR was the devastation President George W. Bush saw occurring with the HIV/AIDS epidemic in Africa.

Providing antiretroviral therapy (ART) is a strong focus of PEPFAR. As of 2022, 20 million patients in 54 countries have received PEPFAR-funded ART. This is a 300-fold increase from 66,500 people in 2004.[5] The initial goal was to treat 2 million people, prevent 7 million infections, and provide humane care. At PEPFAR’s inception, it was estimated that 30 million people in Africa were infected with HIV, but only 50,000 were on ART.[5] To date, it is estimated that over 25 million lives have been saved with ART, and millions of infections prevented. ART not only preserves the lives of those living with HIV but prevents its spread through sexual contact and mother-to-child transmission through birth. Of those on PEPFAR-funded ART, viral suppression has increased from 80% to 95%.

The positive outcomes of PEPAR are not just HIV related. Due to the initiatives, public health infrastructures have been created and strengthened. Thus, countries were better prepared to deal with labs and testing necessary for COVID-19. Additionally, H.R. 1298 contained provisions to help with debt cancellation and restructuring of underdeveloped, heavily indebted countries overburdened by the HIV/AIDS epidemic and other public health crises.[1] PEPFAR has been hailed as one of the greatest achievements of the Bush Administration.

Photo Source: The Borgen Project

Data shows that in 2021 approximately 38.4 million people were living with HIV, 28.7 million people were on treatment, 1.5 million became newly infected, and 40.1 million have died from  AIDS-related illnesses since the start of the epidemic.[6] The fight against HIV/AIDS is far from over. It is imperative that Congress reauthorizes PEPFAR. Is it up for its fourth reauthorization this year. If Congress does not reauthorize PEPFAR, funding for it will not end. However, not reauthorizing it would mean that specific key time-bound provisions would sunset. This could adversely affect the way funds are allocated, the way oversight is conducted, and even how studies concerning its effectiveness and outcomes are conducted, ultimately affecting the appropriation of funds.

[1] H.R.1298 - United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003. Retrieved from https://www.congress.gov/bill/108th-congress/house-bill/1298

[2] Cohen, J (2023, March 14). On Its 20th Anniversary, Reflecting On PEPFAR’s Success In Saving Millions Of Lives In Developing Nations From The Scourge Of HIV/AIDS. Retrieved from https://www.forbes.com/sites/joshuacohen/2023/03/14/on-its-20th-anniversary-reflecting-on-pepfars-success-in-saving-millions-of-lives-in-developing-nations-from-the-scourge-of-hivaids/?sh=44e55f494873

[3] Kaiser Family Foundation. (2022, July 12). The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Retrieved from https://www.kff.org/global-health-policy/fact-sheet/the-u-s-presidents-emergency-plan-for-aids-relief-pepfar/

[4] Moss, K., Kates, J. (2023, March 13). PEPFAR Reauthorization 2023: Key Issues. Retrieved from https://www.kff.org/policy-watch/pepfar-reauthorization-2023-key-issues/

[5] CDC. (2023, March 14). Vital Signs: Progress Toward Eliminating HIV as a Global Public Health Threat Through Scale-Up of Antiretroviral Therapy and Health System Strengthening Supported by the U.S. President’s Emergency Plan for AIDS Relief — Worldwide, 2004–2022. Retrieved from https://www.cdc.gov/mmwr/volumes/72/wr/mm7212e1.htm?s_cid=mm7212e1_w

[6] UNAIDS. (2023) Global HIV & AIDS statistics — Fact sheet. Retrieved from https://www.unaids.org/en/resources/fact-sheet

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.