2018 Progress Report: PEPFAR Strategy for Accelerating HIV/AIDS Epidemic Control (2017-2020)
The American people’s compassion and generosity have saved more than 16 million lives and brought us closer than ever to controlling the HIV/AIDS pandemic – community by community, country by country.
Fifteen years ago when the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) was launched this remarkable progress was hard to imagine. At that time an HIV diagnosis was a death sentence in many countries, and entire families and communities were falling ill. Most of the prior gains in global health and development were being lost and the very fabric of societies were being ripped apart by the loss of teachers, doctors, and nurses. In the hardest-hit regions of sub-Saharan Africa, infant mortality doubled, child mortality tripled, and life expectancy dropped by 20 years. Only 50,000 people in Africa had access to any lifesaving antiretroviral treatment (ART).
Faced with this death and devastation, the United States has responded, resoundingly. The United States is the world’s leader – and largest donor – in the response to the global HIV/AIDS crisis. Since PEPFAR’s establishment in 2003, with strong bipartisan support across three U.S. presidents (George W. Bush, Barack Obama, and Donald J. Trump) and from eight U.S. congresses, the U.S. government, through PEPFAR, has invested more than $80 billion in the global HIV/AIDS response, the largest commitment made by any nation to address a single disease. By focusing resources where the HIV burden was the greatest and the most impact could be achieved, PEPFAR has delivered remarkable results in just 15 years.
PEPFAR is a remarkable example of what is possible when we focus and join hands with countries and communities and ensure all U.S. taxpayer dollars with which we are entrusted are held to account. It demonstrates the impact of U.S. foreign assistance when we focus on the mission with transparency and demand greater effectiveness and efficiency.
PEPFAR has defined the core elements of successful HIV prevention and treatment programming: the full engagement of partner governments at all levels; the rapid development and implementation of core policies that maximize the impact of our investments; the quarterly analysis of program implementation to ensure partner performance and accountability down to the level of where lifesaving services are delivered; and the close engagement of faith and community leaders to increase HIV awareness and provide supportive services.
PEPFAR is a leader in the use of granular data to drive results and increase impact year over year without increasing financial resources (Figure 1). PEPFAR has pioneered the use of large national household surveys – Population-Based HIV Impact Assessments (PHIAs) – to document the impact of HIV programming, surveys that have shown a nearly 50 percent decline in new HIV infections across many of the countries in eastern and southern Africa where the epidemic was raging before PEPFAR began.
The key ingredients for this success include:
Rapid, data-driven expansion of HIV prevention and treatment services targeted by geography and population with greatest need, including the rapid scale up of lifesaving ART focused on achieving viral load suppression; innovative approaches to HIV testing services; VMMC to prevent infections in young men (and thus their subsequent partners); and progress under the PEPFAR-led DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe) publicprivate partnership to prevent HIV infections among adolescent girls and young women.
Supportive partner country HIV policy environments, such as through the rapid adoption and implementation of Test and Start of ART, same-day initiation of HIV treatment, differentiated service delivery models, multi-month fulfillment of prescriptions, and the use of better and cheaper treatment regimens.
Political leadership from partner countries and U.S. ambassadors.
Meaningful engagement of civil society and communities.
Strategic partnerships with the private sector, faith-based leaders and organizations, and others.