Twenty-two years ago today, President George W. Bush asked the nation to join him on World AIDS Day to reaffirm the United States’ commitment to combat HIV, remember those who had lost their lives to AIDS, and support those fighting the disease.
Seven months earlier, President Bush signed the President’s Emergency Plan for AIDS Relief (PEPFAR) into law as an imperative act of mercy for those who believed in the value and dignity of every human life. Today, we celebrate the more than 26 million lives saved and nearly 8 million babies born HIV-free through partnerships with the U.S. President’s Emergency Plan for AIDS Relief.
With the goal of ending HIV/AIDS as a public health threat by 2030, PEPFAR was never intended to go on forever. To safeguard more than 20 years of progress and millions of lives, PEPFAR must focus on how to sustain and accelerate its hard-won gains by helping its partner countries become self-reliant. How PEPFAR transitions the program to its next phase is critical.
We’re close to success in the fight against HIV/AIDS, but challenges persist. Almost 40 million people still rely on lifelong antiretroviral (ART) treatment, and the rate of decline in new HIV infections has stalled in recent years. Violence and inequity in several countries have increased citizens’ chances of contracting HIV. At the same time, HIV/AIDS can wreak havoc in countries, leaving them more desperate and, in turn, vulnerable to insurgencies, security threats, and extremist influence, while undermining opportunities for mutually beneficial investment and trade.
The America First Global Health Strategy, released in September, is a welcome start to PEPFAR’s gradual transition from a mostly U.S-based and U.S.-financed program to local country ownership. It outlines a new model for HIV/AIDS interventions via bilateral agreements between the U.S. and beneficiary governments. This will ensure that programs that have the most impact are implemented and paid for while holding partners accountable.
But the strategy’s timeline for completing these complex agreements is short.
Several PEPFAR partner countries can assume ownership for their programs quickly, while others need more time and technical support.
The number of countries that need help is shrinking, but not every government has been able to make the crucial policy decisions and investments necessary to meet the United Nations’ goals: ensuring that 95% of people living with HIV know their status, 95% of them have access to ART, and 95% of those on treatment are virally suppressed by 2030.
The good news is that PEPFAR and its partners have already done the hard work of building health infrastructure and training the next generation of physicians, nurses, and community health workers. Africa now has more experience in caring for people living with HIV and preventing new infections than any other region in the world.
Countries already on track to reach their goals should turn their focus to addressing treatment gaps and ensuring that all HIV-positive individuals sustain lifelong treatment. Concentrating PEPFAR’s resources on places that still need help by using renewable, performance-based bilateral agreements is the most efficient way to continue to save lives and prevent the waste of U.S. taxpayer dollars.
PEPFAR must streamline its operations, while not risking the tried-and-true methods that led to decades of success – especially the use of strong monitoring and evaluation tools. For example, data collected independently from country governments helps ensure that resources reflect the true needs of the people, rather than the government. Years of countrywide surveys have allowed PEPFAR to hold governments accountable and must continue.
PEPFAR and its partners must also prioritize keeping people on ART. These levels have fallen in recent years, proving that current programs may bring people into clinics but don’t keep them on treatment.
Going off treatment raises the risks that babies will contract HIV or lose their parents to the disease. Drug-resistant strains of the virus are more expensive and difficult to treat and could spread across borders and affect the United States. So, it’s imperative that PEPFAR and partner countries understand why people stop taking ART, learn how to keep them in the health system, and keep making improvements.
PEPFAR’s goal of defeating HIV/AIDS as a public health threat is within sight. The United States should fulfill the lifesaving commitment that it made more than 20 years ago. It can do this by ensuring that countries reach their goals and can sustain them through time-based, data-driven programming, careful implementation, and vigilant oversight. This is a massive undertaking that will take time and care. But done right, partner countries will be able to fund much more of the cost of prevention, treatment, and care.
This World AIDS Day, we may look back and celebrate the incredible progress we’ve made against HIV/AIDS. Then tomorrow, we must get back to work to ensure that we can claim victory together.
Dr. Deborah Birx is senior fellow at the George W. Bush Institute and former U.S. Global AIDS Coordinator; Dr. William R. Steiger is senior advisor at the Bush Institute and former chief of staff at the U.S. Agency for International Development; and Hannah Johnson is senior program manager of global policy at the Bush Institute.
