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PEPFAR: A policy response to the global HIV/AIDS pandemic

Written by April Houston, MSW/MPH, graduate student at Washington University in St. Louis

Progress on HIV/AIDS has been substantial in the last 15 years, thanks to increased attention and funding to combat its spread. It is important to review the past to determine best practices for our present and future.

The first cases of HIV emerged in the 1980s, and rates rose to the point of creating a global panic in the 1990s, provoking action by governments and non-governmental organizations around the world. Viruses are notoriously difficult to cure, and it was not until the mid-1990s that the right combination of pharmaceuticals was developed to address the problem (ART or antiretroviral therapy). The most effective ARTs were expensive and therefore inaccessible by developing countries, including much of sub-Saharan Africa where incidence and mortality rates were skyrocketing. By the end of 1999, an estimated 18.8 million worldwide deaths were attributable to HIV/AIDS and 34.3 million people were living with the virus.

The UN realized the need to create a significant and coordinated approach to the virus, and established the Joint United Nations Programme on HIV/AIDS (UNAIDS) in 1996, combining six different UN bodies with a variety of expertise. They followed up with the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria (often called, more simply, the Global Fund) as a mechanism for fundraising and disbursing funds to combat these significant infectious diseases in low- and middle-income countries, and the US made a founding contribution of $200 million.

Courtesy: Wikimedia commons

One of the most significant governmental investments to address the pandemic was made by the US and known as PEPFAR, the President’s Emergency Plan for AIDS Relief, introduced by President Bush in 2003. The goals of the $15 billion/five year program were to encourage strong leadership to fight HIV/AIDS, to use best practices for HIV/AIDS prevention and treatment, and to ensure effectiveness by partnering with other governments and non-governmental organizations (NGOs), focusing on certain key target areas. It has been reauthorized twice (most recently in 2013), and its impact has been significant. PEPFAR is the US’s largest global health program, investing over $65 billion worldwide and involving many federal departments and agencies including USAID, the Center for Disease Control and Prevention, and the National Institutes of Health for implementation and allocating funds directly to HIV programs in partner countries (most in sub-Saharan Africa) as well as to the Global Fund and UNAIDS.

Significant gains were achieved in the last fifteen years, including a reduction in new HIV infections (35% decrease in incidence since 2000) and an increase in treatment provision to HIV positive individuals around the globe, leading to lower mortality rates (averting nearly 7.8 million AIDS-related deaths. Health systems in developing countries have been boosted, resulting in improved screening for HIV in these regions, improved distribution of ARTs to HIV-positive individuals, increased community education about protection and transmission of HIV, and a substantial reduction in children born with HIV as a result of the infection of their mothers.

Although progress on HIV/AIDS prevention and treatment has been substantial and goals are ambitious for the future, it is perhaps unsurprising that federal budgetary constraints put PEPFAR at risk for budget reduction in 2016. While backing off on funding this global health program may seem like an uncontroversial way to save dollars, an AIDS-free generation is in US interests and within reach, requiring significant prevention and treatment funding to make this a reality. As HIV is treated and controlled, international economies can focus funding and efforts more on development, creating a more stable, peaceful world for everyone.


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United Nations. (n.d.) Fact sheet: What is UNAIDS?

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UNAIDS. (2015, September 26). UNAIDS welcomes bold new HIV prevention and treatment targets from PEPFAR.