From the handful of people — 50,000 — across Africa with access to life-saving treatment for HIV in 2003, to more than 18 million today, the chronology of U.S. leadership against the pandemic that was filling graveyards, orphaning infants, and decimating the continent’s most productive population, when President George W. Bush signed the legislation creating the U.S. President’s Emergency Plan for AIDS Relief reads like a success story.
Since then, the PEPFAR 2017 Annual Report to Congress notes, the response has provided the treatment keeping 11.5 million people alive, 1.1 million of them children. PEPFAR has provided HIV counseling and testing to more than 74 million people, provided care and support services for more than six million orphans and other children affected by the pandemic, protected nearly two million babies from being born with HIV, and given access to medical circumcision to more than 11 and a half million men and boys. In the process it has trained 220,000 health workers, who now can provide life-saving services to their own communities.
For all of that, the report emphasizes, the story of PEPFAR is not a success story yet. What it is, according to PEPFAR’s 13th report, which, along with the numbers, emphasizes themes of partnership, local participation, accountability, and equity, is a story of strategy, that if allowed to continue, will lead to success.
The report highlights partnerships that include the DREAMS initiative, which with support from the Bill & Melinda Gates Foundation, Johnson & Johnson, Gilead and ViiV pharmaceutical companies, and the Nike Foundation’s Girl Effect initiative, supports HIV prevention efforts among teenage girls and young women, the ACT partnership with civil society, government, private and faith-based groups that helped double the number of children on antiretroviral treatment in less than two years, and the partnership with the Elton John Foundation to ensure HIV service access to sexual minority populations facing discriminatory barriers in their countries. It highlights the still-in-progress efforts toward civil society involvement in PEPFAR planning, to inform and guide efforts. And it highlights the accountability that has come with increased openness; the report notes that PEPFAR’s rating on the AID Transparency Index has risen by more than 40 points (from a cloudy 16.1 to a more informative rating of 57.6) in the past several years.
The report highlights meaningful progress, in the first numbers from the door-to-door Public Health Impact Assessments coordinated by ICAP at Columbia University in Malawi, Zambia and Zimbabwe, showing viral load suppression in communities surveyed averaging 65 percent — not too distant from the 73 percent target set by UNAIDS for 2020 if HIV is to be controlled as a global health threat by 2030.
But the report notes, HIV is not controlled yet, and with an approaching boom of adolescents (thanks in part to PEPFAR success in averting infant infections and deaths), the advances made will face their biggest test yet, if not supported. The work, the report says, is only halfway there. But, it indicates, if PEPFAR’s history is a guide, it has the ingredients of a story that will make history.