On Its 20th Anniversary, Reflecting On PEPFAR’s Success In Saving Millions Of Lives In Developing Nations From The Scourge Of HIV/AIDS

It’s been 20 years since former President George W. Bush launched the President’s Emergency Plan for AIDS Relief, or PEPFAR. To date PEPFAR is the largest commitment ever made by any country to tackle a disease. It has saved many millions of lives in developing nations around the globe from the scourge of HIV/AIDS.

In 2003, the U.S. Congress appropriated $15 billion for what was initially a five-year plan to comprehensively address the HIV/AIDS pandemic. In his 2003 State of the Union Address, former President George W. Bush called for a “work of mercy” for HIV/AIDS victims in Africa and the Caribbean. Subsequently, legislation passed which appropriated an unprecedented amount of resources to combat HIV/AIDS. Formally known as The Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003, the law ushered in an era of hope for regions devastated by HIV/AIDS.

The legislation has since been reauthorized three times, and is due for a fourth reauthorization by Congress in September of this year.

Since PEPFAR’s inception in 2003, the U.S. federal government has invested over $110 billion in the global HIV/AIDS response, saving more than 25 million lives and preventing millions of HIV infections, while supporting 41 countries’ efforts to achieve HIV epidemic control. The total amount of $110 billion includes funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria, to which the U.S. government is the largest donor.

Annually, the U.S. government spends $13 billion on global public health, about 42% of which is on HIV.

PEPFAR’s success derives to a large extent on dramatically increasing patients’ access to lifesaving antiretroviral (ARV) drugs. During the 1995 to 2015 period alone, it’s estimated that ARV medications averted 9.5 million deaths worldwide. Moreover, these medications led to economic benefits of $1.05 trillion. For every $1 spent on ARV therapeutics, $3.50 in benefits accrued globally.

A new Vital Signs report from the Centers for Disease Control and Prevention shows that between 2015 and 2022, the percentage of people receiving HIV treatment through PEPFAR who had a viral load test and achieved viral suppression increased from 80% to 95%.

PEPFAR-funded treatments can also prevent transmission of the virus to sexual partners through pre-exposure prophylaxis and reduce the risk of HIV transmission from mothers to children.

In the first 15 years of its existence, the PEPFAR program reported enabling the delivery of more than 2.2 million HIV-negative babies with HIV-positive mothers, facilitating prevention through 15.2 million voluntary male circumcisions, decreasing HIV infection rates in adolescent girls and young women in the highest HIV-burden communities in ten African countries by 25%­ to 40%, delivering care to 6.4 million orphans and other children, training 250,000 health workers, contributing to health-system strengthening in recipient countries, and annually providing HIV testing services to more than 80 million people.

The U.S. government is by far the largest donor to global public health in the world. This includes support for HIV/AIDS, but also neglected tropical diseases (NTDs) such as tuberculosis and malaria, and many other lesser-known ones which cause considerable disease burden and death in the developing world.

Since launching its first NTD program in 2006, the U.S. Agency for International Development has become actively involved in the fight against NTDs. Total U.S. funding for NTDs increased from $15 million in 2006 to $103 million in 2020. Many NTDs can be controlled or even eliminated with relatively low-cost and effective interventions.

PEPFAR is credited with saving millions of lives and helping to change the trajectory of the global HIV epidemic. The program ranks very high on the list of historic U.S. government policy efforts to support international development, (re)build infrastructure, and meet basic food and health needs, such as the Marshall Plan.

However, to sustain momentum it’s imperative that PEPFAR gets reauthorized this autumn, given that almost 38 million people worldwide are currently living with HIV, 1.5 million get infected every year, and 680,000 die from AIDS-related complications.

PEPFAR’s goal is to eliminate HIV as a global public health threat by 2030. To accomplish this will require closing critical gaps, such as health inequities that still exist in populations susceptible to or living with HIV.