As PEPFAR turns 20, a reflection on global health partners’ remarkable progress to end HIV

February 16, 2023
Adolescents in Rwanda receive HIV prevention education as part of the PEPFAR-funded, Pact-led ACHIEVE project. Credit: Pact

This year marks the 20th anniversary of PEPFAR, the President’s Emergency Plan for AIDS Relief. This groundbreaking initiative was launched by President George W. Bush in 2003, with the goal of providing lifesaving treatment and care to millions of people living with HIV/AIDS in countries hardest hit by the epidemic.

My first trip to sub-Saharan Africa was in 2000 at the height of the HIV pandemic. I had experience delivering humanitarian aid in the former Soviet Union and eastern Europe following the Balkan Wars. But that didn’t prepare me for the devastation that HIV caused in South Africa. We visited Wallecedene township, where the conditions looked like something you would see after a nuclear war. People were very sick: six-foot tall men shrunk down to 75 pounds, children with unending diarrhea, mothers and grandmothers exhausted from tending to sick family members, often while sick themselves.

As a public health professional, I’ve had the opportunity to work on effective HIV programs for the past 20-plus years. Over that time, with PEPFAR’s dedication, the outlook in places like Wallecedene changed. Through the dedication and hard work of governments, civil society organizations and health care workers, millions of people have been able to access antiretroviral therapy and other critical services. PEPFAR has been truly transformative, not only in terms of the lives it has saved – an estimated 25 million – but also in terms of the broader social and economic benefits that have resulted from its work.

Now, as I plan a trip to Zambia, where Pact, through the USAID-funded ACHIEVE project, is working on most vulnerable children programming with the Ministry of Community Development and Social Services, I know I will find thriving communities. ACHIEVE focuses on identifying and enrolling vulnerable children into case management and treatment programs. Though the progress on treating HIV in adults has transformed African societies, we still need to close the gap for children. PEPFAR has committed to doubling down on its existing efforts to prioritize this population over the next five years. To contribute to that reinforced effort, Pact has been scaling up the proportion of HIV-positive children enrolled into orphans and vulnerable children programs to ensure that they access and stay on effective antiretroviral treatment. As well, we work at the community level to step up innovations such as multi-month dispensing of antiretroviral medicine that helps to streamline treatment and promote adherence.

"I’ve had the opportunity to work on effective HIV programs for the past 20-plus years. PEPFAR’s impact has been nothing short of extraordinary."

A community case worker with the PEPFAR-funded, Pact-led Kizazi Kipya project visits a family vulnerable to HIV in Tanzania. Credit: Michael Goima/Pact

The PEPFAR Ambassador, Dr. John Nkengasong, recognizes that another key success of PEPFAR’s work is health systems strengthening. PEPFAR has created a strong platform that can be leveraged for pandemic preparedness and other health crises. During the height of the Covid-19 crisis, the ACHIEVE project restructured its programming to adapt training approaches to virtual delivery. This along with business sustainability planning for community-based organizations allowed the global project to continue to reach people with HIV and social services.

HIV is a life-long disease and thus requires sustained effort at the country level to care for those affected. To ensure that health and social welfare systems can respond to these needs, international NGOs work alongside country leaders to integrate HIV services into health systems. Now is the time to take a holistic approach and integrate services for highly prevalent illnesses into the HIV platform. Considering that about 25% of people living with HIV over the age of 50 have hypertension, there is no reason not to screen and treat them in the same health facility. This holistic approach to person-centered care will promote sustainability by making heath care services more efficient and effective. After all, PEPFAR’s goal is to save lives.

At Pact, we believe that engaged communities improve people’s lives. For more than 50 years, we have worked with community and faith-based organizations to help them to advocate for and deliver services that are responsive to their communities’ needs. Pact and ACHIEVE’s capacity development approach targets individuals, institutions and systems equally to give people the skills to enable their organizations to sustainably deliver services and achieve their mission. ACHIEVE supports partners to assess and identify their own capacity strengthening priorities, which is followed with coaching, mentoring and technical support. Our goal, essentially, is to work ourselves out of a job. The localization of the HIV response will sustain the gains that PEPFAR has made and bring innovative ideas to the forefront.

PEPFAR’s impact over the past 20 years has been nothing short of extraordinary. The program has helped to prevent new infections, increase access to testing and treatment, and improve the quality of life for those living with HIV. PEPFAR’s investments in programming like the ACHIEVE project that I lead for Pact have contributed to significant progress toward controlling the HIV epidemic, with many countries now on track to achieve epidemic control by 2030.

I consider myself fortunate to have been a small part of this great public health success. President George W. Bush launched PEPFAR because, as he said, “It was the right thing to do.” As I travel back to Zambia, I will have the privilege of experiencing a society that greatly benefited from this vision.