A critical initiative, PEPFAR has dramatic impact on the HIV epidemic and beyond

More than 20 years ago when President George W. Bush championed an initiative to fight an HIV epidemic that was ravaging nations across the globe, many global health practitioners, including myself, could not have imagined how it would change the trajectory of the disease and impact overall health. The U.S. President’s Emergency Plan for AIDS Relief, also known as PEPFAR, is the largest commitment by any nation to address a single disease in history. Its impact has been unprecedented. In the face of rising global health threats – particularly that of future pandemics – PEPFAR is critical to global health security and must be fully supported.

Its impact on the HIV epidemic is staggering. Since its inception in 2003, PEPFAR has saved 25 million lives and prevented millions of HIV infections, including 5.5 million babies who have been born HIV-free. Nearly 65 million people have received HIV testing services, and more than 20 million men, women and children are on lifesaving antiretroviral treatment today. PEPFAR investments have already supported several countries to achieve HIV epidemic control.

PEPFAR’s investments have also strengthened health care systems. The initiative has trained 340,000 health care workers. This training, along with other health systems strengthening activities, is critical for countries to confront not only HIV, but other public health threats that include Covid-19 and other emerging diseases. It also provides a platform for post-pandemic shifts in global health priorities that are focused on ensuring we have more resilient health systems, promoting and fostering greater equity of health access, and advocating for more investment in primary care and community participation.

Pact is a long-time PEPFAR implementing partner. We have implemented PEPFAR-funded projects across Africa as well as in Asia, Ukraine and the Dominican Republic. We are a technical leader in HIV prevention and mitigation, particularly for orphans and vulnerable children and their caregivers, adolescent girls and young women, key populations, and hard-to-reach groups such as migrants and families in artisanal mining communities. Last year alone, Pact provided services to more than 600,000 HIV-infected and -affected orphans and vulnerable children and their caregivers and delivered high-impact HIV prevention services to over 120,000 adolescent girls and young women to ensure they remain HIV-free.

Like other PEPFAR partners, we have focused particularly on health systems strengthening. While stronger local health systems have played a key role in helping countries move closer to HIV epidemic control, they have also been critical in addressing other public health needs, including the Covid-19 response.

In South Africa, the USAID Government Capacity Building and Support Program, funded through PEPFAR, has largely focused on strengthening local health systems by building the capacity of South Africa's Department of Social Development to better support orphans and vulnerable children to reduce new pediatric HIV infections and ensure that all South African children and adolescents living with HIV receive the care and support they need. The program utilized a “policy to practice” model where national policies became living documents that effectively guided and improved site-level service delivery. By the end of the project, across project-supported districts, 98% of orphans and vulnerable children and youth knew their HIV status, 100% of children and adolescents living with HIV were on treatment and 82% of those were virally suppressed.

In the wake of the Covid-19 pandemic, Pact mobilized with our partners across PEPFAR-funded programs to combat the virus, fight misinformation and disinformation and increase vaccine uptake. In Eswatini, through the Insika ya Kusasa project, we delivered Covid educational materials to caregivers, adolescent girls and young women and community leaders. We trained and deployed community vaccine mobilizers and nurses, held school and faith-based mobilization events and linked community members to clinical partners for vaccination. Roughly 36% of Eswatini’s 1.2 million people have been vaccinated against Covid-19. More than a quarter were mobilized through these efforts.

Taking lessons from the Covid-19 pandemic and understanding how important holistic health is, we have also begun focusing more and more on integrated health. Through a new project in Zambia, we are leading systems strengthening for integrated clinical and community services across HIV, TB/HIV, maternal, newborn and child health, and family planning and reproductive health for marginalized populations.

Every day, we witness first-hand the impact this initiative has had and continues to have on communities across the world. From combatting Covid and gender-based violence to addressing HPV and other noncommunicable diseases, PEPFAR-supported communities are better prepared to respond to current and future health needs and crises, building global health security across the world.

We have made so much progress in the fight against HIV, but the fight isn’t over. There are about 39 million people living with HIV today and progress is lagging in some populations and regions.

We know what is possible when leaders from all walks of life come together to fully support an initiative like PEPFAR. We cannot afford to waiver in our commitment to end AIDS now. We must and should continue to invest in PEPFAR.