[Ip-health] Lancet: PEPFAR at 15 years

Thiru Balasubramaniam thiru at keionline.org
Fri Jul 20 03:59:56 PDT 2018


World Report

PEPFAR at 15 years

Paul Webster
Published: 21 July 2018
DOI: https://doi.org/10.1016/S0140-6736(18)31642-8

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 50 000 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 two-thirds 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 diplomacy, 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-HIV-burden 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

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.”

Thiru Balasubramaniam
Geneva Representative
Knowledge Ecology International
41 22 791 6727
thiru at keionline.org

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