The HIV/AIDS global epidemic

PEPFAR. For those who are not familiar with the term, it is the US President Emergency Plan for AIDS Relief. It was launched in 2003 by President George W. Bush with bipartisan support from the US Congress and strengthened significantly by President Barack Obama.

To-date, the States’ Flagship Global Health Program saw more than 11.5 million people having access to life-saving antiretroviral treatment, more than 11.5 million pregnant women getting free testing and counselling services, more than 11.7 million men getting voluntarily medical male circumcision for HIV prevention, and nearly 2.2 million babies born HIV-free, among many attributes. All costing the United States more than $70 billion over the past 15 years.


As PEPFAR celebrates its 15th anniversary this year, perhaps even more striking is the widespread agreement among the initiative’s biggest backers, that if PEPFAR does not go even further, or if political support falters, the basic mathematics of disease will bring about a new emergency, wiping out a victory that is not yet attained.


PEPFAR’s long-term goal of ending the AIDS epidemic in Africa faces fundamental challenges:


1. Demographics. The population of sub-Saharan Africa is projected to double between now and 2050, and young people – who will comprise the majority in many countries – are at the highest risk for HIV infection.

2.  Around 2.2 million children have been born HIV free to HIV positive mothers because of PEPFAR’s work on preventing mother-to-child transmission. But some of those children, particularly those saved in the early efforts, are now in their teens, and as they grow up, continue to be exposed to HIV.

Across sub-Saharan Africa, teenage girls have among the highest rates of new infections, accounting for 74 per cent of new HIV cases among adolescents, according to PEPFAR’s data.

3. The administration of President Donald Trump, in both its fiscal year 2018 and 2019 budget requests, proposed significant cuts to PEPFAR’s funding, calling for an $800 million reduction in the latest blueprint. Congress, which ultimately determines the US federal budget, has flatly rejected those efforts, and lawmakers have been outspoken in their support for continuing a US legacy that has spanned three presidential administrations.


Last September, former United States Secretary of State Rex Tillerson launched a new strategy, one that left some AIDS experts with questions and concerns about what it would mean for the future of the flagship US global health program and the fight against an epidemic that faces growing demographic challenges.

The strategy for 2017-2020 focuses on “13 priority high-burdened countries” including Botswana, Côte d’Ivoire, Haiti, Kenya, Lesotho, Malawi, Namibia, Rwanda, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe, with an aim to achieve control of HIV/AIDS in those countries by 2020, using the Joint United Nations Programme on HIV/AIDS 90-90-90 framework: Getting 90 per cent of people living with HIV to know their status, 90 per cent who know their status accessing treatment, and 90 per cent of people on treatment with suppressed viral loads.

What concerned several AIDS leaders and advocates is what would happen in the rest of the 50-plus countries where PEPFAR works, including notably South Africa and Nigeria, which have some of the largest numbers of people with the virus. PEPFAR picked the 13 focus countries to see what it would take to get to epidemic control, with the hopes that they would provide a roadmap for other countries as well as help PEPFAR determine what its role would be once countries reach that benchmark. Experts have raised concerns about whether PEPFAR would maintain all patients on treatment, and the main concern is around what will happen to new infected patients. The bottom line is treatment is one of, if not the most powerful tools to stop or slow the AIDS epidemic globally.

Sara Allinder, the deputy director and senior fellow at the Center for Strategic and International Studies’ Global Health Policy Center, is concerned about the years ahead, particularly if Congress does support cuts to PEPFAR funding.

“There is no big donor waiting in the wings if the US government is going to pull back in the immediate or near term,” she said.

If the US takes a step back in funding, there is a question of whether it will even be able to maintain people on treatment, Allinder said.

Rwanda is among the biggest beneficiary of PEPFAR and was recognised for effective use of external funds and making significant gains in the control and prevention of HIV/AIDS, malaria and tuberculosis – leaving a lasting legacy for the country’s health system.

It is good that we leveraged this partnership since 2004 and now are among the 13 priority countries selected by PEPFAR in its effort to support in controlling the epidemic by 2020.

Beyond that, it remains to be seen how the continent shall cope with the epidemic, should anytime PEPFAR withdraw/cut off its funds which is a question of time rather than not.

The writer is the CEO of Unitia Pharmaceuticals.


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