10 Things You Need to Know About PEPFAR on its 10th Anniversary

On Monday, May 27th, the US’ President’s Emergency Plan for AIDS Relief, better known by its acronym PEPFAR, will turn 10.  To mark this milestone, here’s a cheat sheet for the 10 things you should know about this incredible program:

1. It was truly groundbreaking when it was created for its focus on delivering treatment in sub-Saharan Africa.   Although it seems obvious now, with more than 7 million people on treatment in Africa, at the time, the idea of delivering treatment at mass scale was quite controversial. One US government official even notoriously remarked that Africans wouldn’t be able to take their medication consistently because “they didn’t have watches,” and others argued we should only focus on prevention.  But with political commitment to treatment targets, as well as hard work from staff and local officials on the ground, improving access to treatment has been a major—and life-saving—success.

2. It has a proud bipartisan legacy.  Few, if any, other American policy initiatives have seen such widespread bipartisan support sustained over a decade.  From Democrats including Rep. Lee, Rep. Pelosi, Sen. Durbin, and Sen. Kerry to Republicans including Sen. Frist, Sen. Santorum, Sen. Rubio, and Sen. Isakson, so many Members of Colleagues from across the aisle have seen the global fight against AIDS as something (perhaps one of the only things!) they can all agree on.  Even the name of the PEPFAR reauthorization bill reflects this legacy, honoring Rep. Hyde and Rep. Lantos—two men with widely divergent political views who came together on this issue.  PEPFAR has also been a common cause of three US Presidents: President Bush, whose steadfast political leadership was critical in PEPFAR’s early years; President Obama, who has expanded treatment and prevention targets; and President Clinton, who has championed the program since leaving office.

3. It is achieving incredible results.  PEPFAR now estimates that it has provided life-saving treatment for more than 5.1 million people—a number that is set to go up and likely exceed the 6 million target set for the end of 2013.  In 2012 alone, it also provided treatment for 750,000 HIV-positive women to help prevent the transmission of HIV to their babies and support and care for more than 5 million orphans and vulnerable children.

4. It is earning high marks.  A recent Institute of Medicine (IOM) study, carefully researched by neutral parties for nearly 4 years, gave PEPFAR a very positive review in early 2013. It concluded that PEPFAR had been “globally transformative” and had “major positive effects on the health and well-being of individual beneficiaries, on institutions and systems in partner countries, and the overall global response to AIDS.”

5. It is becoming better friends with other global health partners. Around the same time that PEPFAR got its start, another program, the Global Fund, was also just getting its legs in the fight against AIDS as well as TB and malaria.  Over the years, the two programs have come to rely on each other’s complementary strengths, and now often provide integrated support to clinics and communities around the world.  It is also working in tandem with UNAIDS to lead the global effort to virtually eliminate mother-to-child transmission of HIV by 2015.

6. It is evolving with science. When PEPFAR first started, it employed a prevention strategy known as the ABC method: abstain, be faithful, and use condoms.  While the ABC strategy helped prevent HIV infections in some settings, it wasn’t working effectively enough across the board.  Fortunately, as scientific understanding of how to succeed in HIV prevention improved, PEPFAR saw that biomedical tools such as voluntary male circumcision for heterosexual men, earlier combination treatment for pregnant women, and preventative antiretroviral therapy for at-risk individuals could revolutionize the way we target and deliver prevention efforts.  Accordingly, this new approach rooted in science is reflected in PEPFAR’s 2012 Blueprint for an AIDS-Free Generation.

7. It is leveraging its platform beyond HIV.  PEPFAR in recent years has expanded its impact by using its existing programs and expertise to fight other diseases.  Most notably, the Pink Ribbon, Red Ribbon Initiative, created by the Bush Institute and supported by the Obama Administration, uses existing PEPFAR clinics to deliver cervical cancer screening services for women in countries like Zambia.

8. It still has some improvements to make.  As is to be expected of a program that’s only been around a decade, PEPFAR still has room for growth.  In the coming years, it should focus on better defining what it means by a “shared responsibility” with countries, and outline how and when it will provide technical support to countries looking to take on a greater share of their own AIDS programming and financing.  Additionally, as highlighted by CGD analysis, PEPFAR can improve its data collection and dissemination processes to both improve its outcomes and its transparency.

9. It still requires more funding.  Just because much has been achieved by PEPFAR and its partners does not mean that these gains are permanent.  Scaling back PEPFAR funding, right at a time when we have more effective tools to fight the disease and in some places can see a tipping point on the horizon, would be devastating to progress, in some cases allowing the virus to resurge where it is currently under control. Members of Congress and the Obama Administration must fight to reverse cuts and ensure strong support for this vital program!

10. It’s not just about numbers—it’s about people.  From the people who have led PEPFAR (including Amb. Mark Dybul—now head of the Global Fund—and Amb. Eric Goosby) to the recipient country partners working hand in hand with unsung staff, PEPFAR has demonstrated some of the best of what America can offer to the rest of the world and what leadership from recipient countries can achieve for their own citizens.  And ultimately, it’s worth celebrating millions of people like Connie, who are living healthy and dynamic lives today because they are able to access antiretroviral treatment.

If you want to support the fight against AIDS, add your name to our petition urging world leaders to scale up commitments to the Global Fund to Fight AIDS, TB and Malaria and help make the beginning of the end of AIDS a reality by 2015.