The US President’s Emergency Plan for AIDS Relief celebrateв its 15th anniversary this year. On the occasion of this event in an independent, international weekly general medical journal “Lancet” was published an article, the author of which is Paul Webster.
Below we propose to read the full version of the article.
PEPFAR at 15 years
The US President’s Emergency Plan for AIDS Relief celebrates its 15th anniversary this year, prompting calls for continued support for the initiative. Paul Webster reports.
15 years after then-US President George W Bush launched the President’s Emergency Plan for AIDS Relief (PEPFAR), which has invested more than US$80 billion in the global fight against HIV/AIDS since 2003, US officials and HIV/AIDS analysts alike still commend its vastly important contributions. Its strategy for the future, they say, offers substantial hope that the global pandemic can be brought under control.
Marking PEPFAR’s 15th anniversary in May, US Secretary of State Mike Pompeo described it as “money well spent”. HIV/AIDS prevention and treatment through PEPFAR, Pompeo said, have “reached historic highs, especially among adolescent girls and young women”. He added that, in addition to saving lives, “PEPFAR enables economic growth, reinforces stability and security in key regions, and accelerates progress towards global health security”.
When PEPFAR was created, only 50000 people in Africa were receiving treatment for HIV. The programme now supports more than 14 million men, women, and children receiving treatment. PEPFAR has also enabled more than 2·2 million babies to be born HIV-free to HIV-positive mothers and assists more than 6·4 million orphans, vulnerable children, and their caregivers affected by HIV/AIDS, according to the State Department. The Plan has supported more than 15·2 million men and boys with voluntary medical male circumcision to help prevent HIV infection. New PEPFAR data shows a 25–40% decline in new HIV diagnoses among adolescent girls and young women in almost twothirds of the communities with the highest burden of HIV implementing PEPFAR’s Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe public–private partnership across ten African countries.
Annie Haakenstad, a researcher with the Seattle-based Institute for Health Metrics and Evaluation, who co-authored a study of domestic and international spending on HIV/AIDS published in The Lancet, says PEPFAR’s 15th anniversary offers the opportunity to take stock as global spending on HIV/AIDS declines. “Millions of people infected with HIV have been able to live long and productive lives, thanks to the investments of PEPFAR and other international organisations in the distribution of [antiretroviral] drugs and other interventions”, she told The Lancet. “Development assistance for HIV/AIDS has declined in recent years—in total, and from the USA. Many nations’ programmes are at risk for gaps in funding. Such gaps are not just numbers. They represent life or death scenarios for people infected with—and affected by—HIV/AIDS.”
Despite Pompeo’s commendations, PEPFAR is in jeopardy. In February, President Donald Trump’s administration tabled a budget request to Congress that would cut funding for PEPFAR by 18%, or $859 million.
In March, UNAIDS stressed that international disbursements for HIV in low-income and middle-income countries declined by 7% in 2016, reaching their lowest level since 2010, the agency noted. “In a time of expanding needs and diminishing means, the pace of domestic investments has not compensated fully for the decline in international support”, it warned.
Ambassador Deborah Birx, US global AIDS coordinator and US special representative for global health dip - lomacy, told The Lancet that PEPFAR has flourished through three presidential administrations and eight US Congresses, and has made the US Government the world’s largest bilateral donor to the global HIV/AIDS response. “For the first time in modern history, we have the opportunity to control a pandemic without a still much-needed vaccine or a cure, laying the groundwork for eventually eliminating HIV”, she said.
Under the PEPFAR Strategy for Accelerating HIV/AIDS Epidemic Control (2017–20), announced by former Secretary of State Rex Tillerson last September, “up to 13 high-HIVburden countries are now poised to achieve epidemic control by 2020 with PEPFAR support, creating a roadmap for the over 50 countries where PEPFAR works”, Birx explained.
“The Trump administration remains deeply committed to the global HIV/AIDS response and to demonstrating clear outcomes and impact for every US dollar spent”, Tillerson said when announcing the new strategy. “We want to look back together and recognise that it was here, at this point in time, that our accelerated focus led to a world free of HIV/AIDS.”
That Nigeria wasn’t included in the list of focus countries in the new PEPFAR strategy has generated controversy, but Birx says PEPFAR is now investing heavily in data gathering in Nigeria to better refine its strategies.
In championing PEPFAR’s future mandate, Birx emphasised the need “to use data, innovation, and partnerships to drive equity. This includes more effectively and efficiently reaching and serving children, young women, young men, and key populations, all of whom are too often left behind.”