Sub-Saharan Africa is the most affected region in the global AIDS epidemic. It accounts for about two-thirds (66%) of all people infected with HIV globally. In 2014, an estimated 25.8 million people in that region were living with HIV. Of those, 1.4 million adults and children were newly infected. In addition, 790,000 people died from the disease that year. Worldwide, an estimated 2 million people were newly infected, and 1.2 million people died of AIDS. In 2015, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that 36.9 million people were living with HIV worldwide.
President’s Emergency Plan for AIDS Relief (PEPFAR)
Countries with PEPFAR-funded programs include:
- Asia Regional (China, Laos, and Thailand)
- Caribbean Regional (Antigua and Barbuda, Bahamas, Barbados, Dominica, Grenada, Jamaica, St. Kitts and Nevis, St. Lucia, St. Vincent, Suriname, and Trinidad and Tobago)
- Central America Regional (Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama)
- Central Asia Regional (Kazakhstan, Kyrgyz Republic, Tajikistan, Turkmenistan, and Uzbekistan)
- Côte d'Ivoire
- Democratic Republic of the Congo
- Dominican Republic
- Papua New Guinea
- South Africa
- South Sudan
History of PEPFAR
On May 27, 2003, the United States Leadership Against Global HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (Public Law 108–25) was signed into law creating the President’s Emergency Plan for AIDS Relief (PEPFAR). PEPFAR is the largest commitment ever made by any nation for an international health initiative dedicated to a single disease. The plan emphasizes a “whole government” response. It draws from each agency’s core competencies to provide the most comprehensive, coordinated, and targeted interventions. Many federal departments and agencies are involved in PEPFAR’s implementation, including the U.S. Department of Health and Human Services (HHS), U.S. Department of State, U.S. Agency for International Development (USAID), U.S. Department of Defense, and the Peace Corps.
PEPFAR’s first iteration focused on emergency response and allocated $15 billion over a five-year period. The initial focus was on 15 countries in sub-Saharan Africa, Asia, and the Caribbean. Its goals were:
- Provide treatment to 2 million HIV-infected people,
- Prevent 7 million new HIV infections, and
- Provide care to 10 million people infected and affected by HIV/AIDS, including more than 4 million orphans and vulnerable children and prevention of mother-to-child treatment services during nearly 16 million pregnancies.
On July 30, 2008, the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 was signed into law. It authorized the contribution of up to $48 billion over five years to combat global HIV/AIDS, tuberculosis, and malaria. This second phase of PEPFAR focused on sustainability through local partnerships with specific, quantifiable goals. Those goals were to:
- Provide treatment for at least 3 million people,
- Prevent 12 million new infections, and
- Care for 12 million people, including 5 million orphans and vulnerable children.
For this second phase of PEPFAR, U.S. government teams in 22 countries developed and signed Partnership Frameworks with the host country governments. The Partnership Frameworks cemented mutual accountability and collaboration for priority HIV/AIDS activities. These agreements were a hallmark event between 2009 and 2012 that launched a new era of collaborative planning and health systems strengthening activities with partner governments. An emphasis was also placed on increasing the impact of PEPFAR’s investments by scaling up access to antiretroviral therapy (ART), preventing mother-to-child transmission, and voluntary medical male circumcision.
With significant progress made, PEPFAR entered into its third phase in 2013, ‘Controlling the Epidemic,’ with the mandate to attain UNAIDS’ ambitious 90-90-90 goal: 90% of people with HIV diagnosed, 90% of them on ART and 90% of them virally suppressed by 2020. While maintaining its commitment to partnership, this approach is driven by data in order to strategically target geographic areas and populations for maximum impact. The President’s FY 2016 budget request for PEPFAR is $6.5 billion with bilateral support provided to 41 countries and regional programs in Africa, the Middle East, Asia, Europe, the Americas, and the Caribbean.
- Impact: efficient and effective control of the HIV epidemic
- Efficiency: increased transparency, oversight, and accountability across PEPFAR
- Sustainability: sustainable governance models and increased country fiscal contributions and local partner implementation
- Partnership: renewed national and global commitments to an AIDS-free generation
- Human Rights: promotion and protection of human rights for all, including LGBT people, women and girls, and other vulnerable populations