2023-12-04 15:03:20
Twenty years ago, then-President George W. Bush launched the President’s Emergency Plan for AIDS Relief (PEPFAR). When I took office as Minister of Health of Ethiopia, I used funds from this program to save lives and reduce the HIV epidemic (in English) which swept my country and a large part of the continent. The leadership shown by the United States through PEPFAR has helped change the course of HIV in Africa.
Two decades later, and today as Director-General of the World Health Organization, I have seen the impact that PEPFAR has around the world and particularly in Africa, Asia and Latin America . The statistics are impressive: in twenty years, the program has saved 25 million lives and enabled 20 million people living with HIV to start antiretroviral treatment and 5.5 million babies to be born without HIV. Moreover, five countries in sub-Saharan Africa – which have been particularly affected – are now on track to achieve ambitious global targets: 95% of people living with HIV know their status, 95% of people having had a positive diagnosis for the virus receive treatment and 95% of all people receiving life-saving medicines will have their viral load suppressed by 2025.
However, all this progress may now be in jeopardy.
The rising cost of living, new conflicts and the climate crisis are putting development aid under pressure. This situation dries up funding and diminishes interest in programs like PEPFAR that have had such an impact on millions of people whose place of birth no longer determines their condemnation to poor health and premature death.
As the American people debate whether to extend PEPFAR authorization for the next five years, it is worth reflecting on the legacy of this historic program for HIV and, more broadly, health worldwide.
In the 1980s, HIV was a death sentence for people who contracted it. However, in the mid-1990s, powerful new therapeutic combinations were developed that radically changed the course of the disease and the global epidemic. Patent rules kept these medicines largely out of reach for people in low- and middle-income countries, leading to millions of unnecessary deaths and 14 million orphans. in the world.
The media focused on a deadly global epidemic, declining life expectancy in Africa and threats to economies and health security. If we add to this the increasingly present advocacy on the part of certain citizen movements, all this has prompted the American population to demand that something be done. So lawmakers on both sides put politics aside and committed to one of the most ambitious health programs ever attempted.
Two decades later, PEPFAR’s record in terms of lives saved and infections prevented is a real source of pride for the population and the political world, of whatever stripe.
PEPFAR investments continue to have a mobilizing role, revolutionizing not only the fight against HIV, but also the way countries deliver health services. PEPFAR has not only made funds available to purchase life-saving tests and treatments; it has also invested in the systems and infrastructure needed to ensure they reach the people who need them.
This approach has made it possible to considerably reduce the number of HIV infections, but also deaths due to malaria and tuberculosis. It has also reduced the number of mothers and babies dying during childbirth.
WHO is working with countries to build on these achievements. This is how it certified the elimination of mother-to-child transmission of HIV in 16 countries. Other African countries are stepping up their efforts and doing everything possible to achieve ambitious elimination targets.
Global progress in the fight against HIV is strong thanks to PEPFAR and its bilateral support to countries and ministries of health. Available data have been used judiciously and carefully to measure incidence and mortality and identify populations being left behind. The integration of this data into health programs has ensured that resources are largely directed towards those most at risk, which is essential to bend the curve of new infections.
PEPFAR’s global impact has never been more evident. Testing and treatment rates have increased and the number of new HIV infections is at its lowest level in decades in 2022, with the largest declines in countries and regions where the burden of the virus is highest. higher.
However, many people still start treatment too late and die from HIV, often without telling their friends and family because of the stigma and discrimination such disclosure would expose them to. The number of new infections among children has not declined as quickly as we hoped and there are stark disparities among key at-risk communities. The fact remains that innovations making it possible to overcome some of these difficulties, such as HIV self-testing, long-acting prevention and different treatment options, are becoming more accessible and we are seeing new momentum to end AIDS among children.
When President Bush launched PEPFAR, the goal of an AIDS-free generation seemed completely implausible. It is now very concrete and achievable.
PEPFAR was a driving force against a global threat to public health, but it also provided a sign of hope and solidarity from the American people to their brothers and sisters around the world. Today, U.S. leadership remains more crucial than ever.
By reauthorizing PEPFAR, lawmakers would send a clear signal to the world that the United States remains committed to ending AIDS and ensuring a safe and healthy world for all. Building bridges across political spectrum has changed the course of the global AIDS epidemic. Preserving this bipartisan approach is our best hope for one day relegating this disease to the history books.
Dr Tedros is the Director-General of the World Health Organization
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