15 Years of the President’s Emergency Plan for AIDS Relief (PEPFAR)
15 ways USAID is working toward epidemic control
Fifteen years ago, on May 27, 2003, President George W. Bush signed into law the legislation that authorized the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). It would become the largest single global health initiative in the world, and it continues to save millions of lives.
USAID plays a key role in PEPFAR, particularly in the hardest-hit regions in sub-Saharan Africa.
An estimated 36.7 million people worldwide are living with HIV/AIDS, 1.8 million newly infected in 2016 alone. While these numbers can be discouraging, the overall trend is a positive one. As a result of PEPFAR, USAID and other implementing partners have supported life-saving antiretroviral treatment for more than 14 million people; tested and counseled more than 85.5 million people; provided care and support for nearly 6.4 million orphans and vulnerable children and their families; and trained more than 250,000 health workers to deliver care for HIV.
As we celebrate PEPFAR’s 15th anniversary, USAID is taking a look back at progress the program has made — through the generosity of the American people, together with local, public, private and faith-based partners, and country governments — in pursuit of sustainable control of the HIV/AIDS epidemic. Take a look at 15 key steps toward our global goal of a more secure, prosperous and AIDS-free world.
1. Empowering Adolescent Girls and Young Women
USAID is a key implementer of PEPFAR’s efforts to ensure adolescent girls and young women can live Determined, Resilient, Empowered, AIDS-free, Mentored and Safe lives (known as the DREAMS Initiative) in sub-Saharan Africa by addressing the factors that increase their risk of HIV infection. Today, research shows that DREAMS programming has contributed to a 25–40-percent decline in new HIV diagnoses among adolescent girls and young women in areas with the heaviest concentrations.
2. Keeping Babies and Vulnerable Children HIV-Free
Under PEPFAR, USAID helped launch the first programs to prevent the transmission of HIV from mothers to their children. Today 2.2 million babies have been born HIV-free who would have otherwise been infected. USAID partners also work to improve the health and well-being of children who are living with, and are affected by, HIV by providing critical care and support for more than 6.4 million orphans, vulnerable children, and caregivers to mitigate the physical, emotional and economic impact of the disease.
3. Reaching the Most At-Risk Populations
USAID, through the PEPFAR LINKAGES project, leads the first global grants dedicated to reducing the transmission of HIV and improving enrollment and retention in care among the most-at-risk and difficult-to-reach populations, by providing services free of stigma and discrimination.
4. Engaging with Civil Society Organizations
Under PEPFAR, USAID funds civil society organizations — including community-based, non-governmental and faith-based groups — across the spectrum of the prevention, care and treatment of HIV/AIDS, including advocacy and service delivery.
5. Mobilizing Domestic Resources for the HIV/AIDS Response in Partner Countries
USAID works with governments and other stakeholders in nine countries under PEPFAR’s Sustainable Financing Initiative to mobilize domestic resources to control the epidemic.
6. Building Stronger Health Systems
USAID examines the supply, quality, and retention of a country’s health workforce through our Human Resources for Health programming to help build stronger systems better prepared to respond to their own epidemics. USAID has supported training for nearly 250,000 new health workers to deliver care for HIV and other conditions.
7. Optimizing Simpler, Safer, More Affordable HIV/AIDS Treatment
Under PEPFAR, USAID is contributing to the efforts of a wide range of stakeholders to make optimized antiretroviral therapy available in low- and middle-income countries, which will result in better, less expensive treatment options.
8. Revolutionizing the Delivery of HIV/AIDS Treatment
Under PEPFAR, USAID funds the scale-up of innovative models to deliver HIV treatment to reduce costs and improve the retention and adherence of patients. Our partners have developed and implemented multi-month scripting and dispensing, while also coordinating with ePharmacy systems and remote antiretroviral dispensing units in sub-Saharan Africa.
9. Researching and Developing HIV Vaccines
As part of PEPFAR, USAID funds the acceleration of research and development for an HIV vaccine via a five-year cooperative agreement, through 2021, with the International AIDS Vaccine Initiative and the AIDS Vaccine Advocacy Coalition.
10. Investing in Biomedical Interventions
Under PEPFAR, USAID funds efforts to speed up the introduction of new safe, effective and affordable prevention products, including oral pre-exposure prophylaxis (PrEP) and the dapivirine ring — the first discrete, long-acting, HIV-prevention product designed specifically for women that provides sustained release of the antiretroviral drug dapivirine.
11. Harnessing Data in All HIV Programming
USAID works with the latest epidemiological data produced by PEPFAR partners and a range of analytical tools to monitor both the HIV epidemic and our programs to prevent HIV and care for and support those infected with, and affected by, the disease. We support PEPFAR by collecting strategic information, developing health informatics systems, and evaluating expenditure data to inform future evidence-based interventions.
12. Educating Men on Voluntary Medical Male Circumcision
Under PEPFAR, USAID funds the scale-up of voluntary medical male circumcision (VMMC) as a critical intervention to reduce HIV in eastern and sub-Saharan Africa, and as a means to offer direct protection to women against the human papillomavirus (HPV), which causes cervical cancer. USAID partners have performed more than 15.2 million VMMCs in eastern and southern Africa.
13. Integrating Youth in HIV/AIDS Programming
As part of the PEPFAR strategy for epidemic control, USAID is looking critically at how we are going to meet the long-term needs of 20.9 million people currently on antiretroviral treatment, and the impact of the “youth bulge” — in which the hardest hit areas in sub-Saharan Africa are currently experiencing a dramatic increase in their population under age 18. USAID’s youth programming strives to reach young people with HIV-prevention services and link HIV-positive youth to care and treatment to improve their quality of life, and reduce their risk of passing the virus on to others.
14. Striving to Meet the 90–90–90 Global Goals
Under PEPFAR, USAID continues to work toward sustained epidemic control and to reach the “90–90–90” global goals set by the Joint United Nations Programme on HIV/AIDS (UNAIDS): 90 percent of the population should know their status, 90 percent of those diagnosed should receive antiretroviral therapy, and 90 percent of those who are receiving treatment should achieve viral suppression (meaning an increased likelihood of improved health outcomes and a decreased likelihood of transmitting the virus) by 2020. Based on evidence from PEPFAR’s population-based HIV-impact assessments, Lesotho, Malawi, Swaziland, Zambia and Zimbabwe are each close to reaching the 90–90–90 targets.
15. Supporting Millions on Life-Saving Treatment
USAID, with other PEPFAR implementing partners, has funded life-saving antiretroviral treatment for more than 14 million men, women and children. Our mission remains to test, treat and care for people around the world as we set our sights on achieving zero new HIV infections.
Finally, underlying every one of these 15 points is the collaboration that has made our success possible. This team effort includes inter-agency cooperation with the U.S. Department of Health and Human Services that goes back decades. Together, we are working to increase the U.S. Government’s impact on global health to reach more people, more effectively, while building safer and more prosperous societies.
About the Author
Mark Green is the Administrator of USAID. Follow him @USAIDMarkGreen. Our development efforts advance American interests by promoting global security, prosperity and self-reliance.
