20 years ago, United States President George W. Bush launched the US President's Emergency Plan for AIDS Relief (PEPFAR). When I took over as Minister of Health of Ethiopia, I used the funds from the program to save lives and reverse the HIV epidemic that hit my country and much of the continent. U.S. leadership through PEPFAR helped change the course of HIV in Africa.
Two decades later, and now as Director General of the World Health Organization (WHO), I have seen the global impact of PEPFAR, and particularly in Africa, Asia and Latin America. The statistics are impressive: in 20 years, the program has saved 25 million lives, enabled 20 million people with HIV to start antiretroviral treatment, and prevented 5.5 million babies from being born with HIV. And five countries in sub-Saharan Africa—which were especially affected—are now meeting the ambitious global goals of having 95% of people living with HIV know their HIV status, 95% of those diagnosed with HIV receive treatment and that 95% of all those receiving life-saving medicines achieve viral suppression by 2025.
However, all of these achievements could now be in jeopardy. Rising costs of living, new conflicts and the climate crisis are putting pressure on foreign development aid. This is reducing funding and interest in programs like PEPFAR, which have had such a broad impact on millions of people that they are no longer condemned to poor health and premature death because of where they were born.
As U.S. representatives continue to debate whether to reauthorize PEPFAR for the next five years, it is worth reflecting on the legacy of this historic program for HIV and, more broadly, for global health.
In the 1980s, HIV was a death sentence for people who became infected. However, by the mid-1990s, new and powerful drug combinations had been developed that radically changed the course of the disease and the global epidemic. Due to patent rules, these drugs were largely out of reach for people living in low- and middle-income countries, ultimately meaning millions of unnecessary deaths and 14 million orphans worldwide.
With media attention focused on a global epidemic of deaths and declining life expectancy in Africa, threats to economies and health security, and growing advocacy work by popular movements, The American public demanded action. And lawmakers on both sides put aside political divisions and committed to one of the most ambitious health programs ever undertaken.
Two decades later, PEPFAR's record of saving lives and stopping infections is something that people and politicians of all stripes can be proud of.
PEPFAR's investment continues to be catalytic, driving a revolution not only in the fight against HIV, but also in the way countries deliver health services. Not only has it provided the funds to purchase life-saving tests and treatments, but it has also invested in the systems and infrastructure necessary to ensure they reach the people who need them.
New HIV infections among children have not decreased as quickly as we expected
This approach has helped to dramatically reduce not only HIV infections, but also deaths from malaria and tuberculosis, as well as the number of mothers and babies who die in childbirth. WHO has worked with countries to scale up these achievements and has certified the elimination of mother-to-child transmission of HIV in 16 countries. Other African countries are stepping up efforts to achieve ambitious elimination goals.
Global progress against HIV is strong thanks to PEPFAR and its bilateral support to countries and health ministries. Data have been used wisely and carefully to measure incidence, deaths and populations left behind. Integrating that data into health programming has ensured that the majority of resources go to those most at risk, which is key to reversing the curve of new infections.
The global impact of PEPFAR remains clearer than ever. Testing and treatment rates have increased, and 2022 saw the lowest number of new HIV infections in decades, with the largest declines in countries and regions with the highest HIV burden.
However, many people continue to start treatment too late and die with HIV, often without telling their friends and family because of the stigmatization and discrimination they would face. New infections among children have not decreased as rapidly as we expected, and there are stark disparities in key risk communities. However, innovations to overcome some of these challenges, such as HIV self-testing, long-acting prevention and therapeutic options, are becoming more accessible, and there is renewed momentum to end AIDS in children.
When President Bush launched PEPFAR, the goal of an AIDS-free generation seemed completely inconceivable. Now it is very real and feasible. PEPFAR not only acted as an engine against a global public health threat, but it was also a sign of hope and solidarity from the American people towards their brothers and sisters around the world. Today, American leadership remains as decisive as ever.
By reauthorizing PEPFAR, lawmakers would send a clear signal to the world that the United States remains committed to ending AIDS and ensuring a healthy and safe world for all. Overcoming the political divide changed the course of the global AIDS epidemic; Maintaining that bipartisan approach is our best bet to one day relegate the disease to the annals of history.
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