Insights from Bush Institute global health expert Hannah Johnson
PEPFAR’s impact is often measured in numbers, but behind every statistic is a life saved. Each data point represents a person whose story is a powerful reminder of what this program makes possible.
Nozi Samela is one of the early beneficiaries of PEPFAR and a living example of the program’s transformative impact on people’s lives. She was diagnosed with HIV 20 years ago while pregnant with her first child but, thanks to PEPFAR, received antiretroviral treatment and was mentored by HIV-positive mothers, which ultimately helped her give birth to a healthy, HIV-free baby. Nozi said the day she learned her son was HIV-negative was “one of the happiest days of my entire life.” Since then, she has become a mentor to other HIV-positive mothers herself and an advocate for HIV prevention and treatment.
Once rare, success stories like Nozi’s have become increasingly common because of PEPFAR. While the program has saved more than 26 million lives in its 22 years of existence, there’s still work to be done to achieve the goal of eliminating HIV/AIDS as a public health threat by 2030. Terminating the program now would jeopardize decades of progress, put millions of lives at risk, and also leave a power vacuum in many African countries that Russia and China are eager to exploit.
PEPFAR’s achievements over the past two decades should be sustained through a gradual and strategic transition to country ownership. Only then can the legacy of PEPFAR endure and evolve to meet future health challenges.
Figure of the Week
500 Million
Last week the White House submitted rescission proposals to Congress for the Department of State, the U.S. Agency for International Development (USAID), and other foreign investment programs. This includes $500 million of the $6 billion appropriated in fiscal year 2025 for global health programs like PEPFAR.
Until countries assume ownership of all HIV programming over the next few years, it’s critical to maintain funding for HIV treatment and prevention. U.S. investment and partnership is the only way to ensure those living with HIV survive, that PEPFAR’s extraordinary life-saving work is sustained, and that we end HIV/AIDS as a public health threat. I outline what’s next and policy considerations for the administration and Congress in a recent piece for the Bush Institute.
Ally Updates
Before the 78th World Health Assembly, global health leaders, government officials, pharmaceutical companies, and civil society representatives met at the UNAIDS headquarters in Geneva for the High-Level Multisectoral Leadership Dialogue on HIV Prevention. The discussion centered on expanding access to long-acting HIV prevention tools and building sustainable prevention systems.
Dutch Ambassador Paul Bekkers concluded the event with a strong call to action: “Not acting now means leaving a larger HIV epidemic to the next generation. Or we can put the world on course to achieve HIV epidemic control and eventually the end of AIDS as a threat to public health. As members of the Global HIV Prevention Coalition, we can achieve this together.”
In the News
- KFF recently published a PEPFAR reauthorization explainer outlining the program’s legislative history, the difference between its authorization and appropriation, and current policy considerations for next steps.
- Think Global Health’s Emily Bass was recently in Uganda and Tanzania investigating the impact of changes to U.S. foreign investments on in-country PEPFAR programming. Bass found that many Ugandans and Tanzanians are terrified given the lack of communication on the status of national HIV programming. Courageous indigenous healthcare workers and counselors shared the status of the program and challenges they face today.
- Recent changes to PEPFAR programs in Uganda led to clinic closures and interruptions in pediatric HIV treatment, prompting panic and school withdrawals in rural communities, reported Brian W. Simpson in Hopkins Bloomberg Public Health Magazine. Though some funding was restored, the failure to reauthorize PEPFAR as well as shifts in program support – like ending support for voluntary medical male circumcision – now threaten decades of HIV progress.
- The Center for Strategic and International Studies (CSIS) recently published a Q&A discussing the impact of the administration’s 120-day foreign aid review and exploring how a leaner PEPFAR can remain dynamic, be strategically rebranded, and stay relevant beyond 2030.
- A recent Christianity Today article outlines how recent terminations and freezes in U.S. foreign assistance have led Kenya to strategize new pathways for HIV sustainability, including in-country pharmaceutical supply chains and diagnostic systems. However, without ongoing support from PEPFAR in the short term, these critical, long-term advancements may not be a reality.
- A recent article in STAT showcases the tremendous challenges posed to PEPFAR over the past several months. HIV/AIDS advocates and experts showcase how countries and communities have and can continue to adapt to changing finances to ensure people living with HIV continue to access life-saving care.
