PEPFAR: Ten Years of Saving Millions of Lives

Posted by Eric Goosby and Anthony Fauci
May 27, 2013
Sand Sculpture of AIDS Ribbon on a Beach in India

Ten years ago today, the United States Congress, in a remarkable display of compassion and bipartisanship, passed overwhelmingly legislation that established an historic and transforming global health program now known as PEPFAR -- the President's Emergency Plan for AIDS Relief.

At the time that PEPFAR was conceived of and then established during the George W. Bush administration, the world was witnessing first-hand the destruction of an entire generation of individuals in the prime years of their lives and the reversal of remarkable health and development gains, particularly in sub-Saharan Africa and to a lesser extent in other developing nations. Rates of new HIV infections were rising rapidly, and hospitals, communities, and families were often too under-resourced and overwhelmed to cope with the enormity of this burden. At that time in 2003, despite the availability of life-saving antiretroviral therapy (ART) in most countries in the developed world, in southern Africa and other regions of the developing world, an HIV diagnosis meant a virtual death sentence, since few had access to such drugs.

Today, as we mark the 10th anniversary of PEPFAR, the situation has changed dramatically. Plummeting life expectancy rates in much of Africa have been reversed; HIV-infected, but healthy, fathers and mothers who are receiving therapy are able to return to work, care for their families, and spur economic development. Doctors, nurses, and community health workers, who once had little to offer their patients beyond a more dignified death, are delivering life-saving ART to millions of people. AIDS-related mortality has declined by more than 26 percent since its peak in 2005. Where despair once cut a devastating swath through so many communities and countries, hope has been renewed.

With regard to the prevention of HIV infection, globally, in the decade since PEPFAR began, new HIV infections have declined by nearly 19 percent. Between 2009 and 2011, new HIV infections among children, still an important component of the epidemic in many southern African countries and other regions in the developing world, declined by 24 percent globally, compared to a 23 percent decline in the previous six years. Not only is progress happening, but its pace is accelerating.

According to a recent report evaluating PEPFAR by the Institute of Medicine, "PEPFAR has played a transformative role with its contribution to the global response to HIV." As of the end of September 2012, PEPFAR was directly supporting 5.1 million people on ART -- a more than three-fold increase in just the past four years. Last year alone, PEPFAR reached more than 750,000 pregnant women living with HIV with antiretroviral drugs to prevent mother-to-child transmission (PMTCT), allowing an estimated 230,000 babies who would have otherwise been infected to be born without HIV.

One key driver of this progress is the development and implementation of a combination prevention program. Just as it became clear that multiple HIV medicines, when used in concert, more effectively control replication of the virus in the body, it was shown that multiple prevention interventions, when implemented together, can more effectively reduce new HIV infections at the population level. This evolution in our thinking and approach to preventing HIV infection has reflected scientific innovation together with practical implementation. Landmark scientific advances, coupled with lessons learned from a decade of implementing programs under PEPFAR, have given us the tools, knowledge, and experience needed to achieve an AIDS-free generation.

Recent statistics show that the promise of an AIDS-free generation is truly within our reach, as President Obama powerfully articulated in his State of the Union address earlier this year. More countries than ever before have reached, or surpassed, the programmatic tipping points in their HIV epidemics -- the point at which the annual increase in adult patients receiving treatment exceeds the number of annual new adult HIV infections. Reaching this tipping point is a key indication that a country is on the path to achieving an AIDS-free generation -- and the more countries that achieve this goal, the closer we will be to ending the HIV/AIDS pandemic.

While PEPFAR is certainly the largest and most successful foreign health assistance program in history, it is clear that the United States cannot be alone in this endeavor. Other partners, including the Global Fund to Fight AIDS, Tuberculosis and Malaria, to which the United States is the largest contributor, multilateral organizations, the private sector, civil society, and host countries must all share in the responsibility. And, as PEPFAR enters its second decade, countries with a high burden of HIV disease must assume greater ownership for addressing the health needs of their own people by building strong and sustainable health systems.

PEPFAR represents the very best of America -- the extraordinary generosity and compassion of the American people. Through PEPFAR, we are helping to deliver a better future to millions around the globe. Although much remains to be done in the future, the 10th anniversary of PEPFAR is something to celebrate now.

Ambassador Eric Goosby is the U.S. Global AIDS Coordinator and head of the State Department's Office of Global Health Diplomacy. Dr. Anthony Fauci is the Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health.

Editor's Note: This entry also appears on The Huffington Post.

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