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Beyond Lives Saved
Today, we celebrate the global fight against AIDS, but we must also remember the 35 million people who have died and the 37 million still living with the disease.
Globally, the number of people who know their status, are undergoing treatment, and are achieving viral suppression is trending in a positive direction. Thorough data evaluations have led to increasingly smart decisions about where, how, and when to prevent and treat HIV.
- 13.3 million people are on antiretroviral treatment
- 2.2 million babies have been born disease-free to HIV-positive mothers
- 85.5 million people have been tested for HIV
- 15.2 million men and boys have received voluntary medical circumcision (shown to decrease transmission by 60 percent)
PEPFAR's use of district-level data to evaluate and monitor its program affirms its responsible use of American tax dollars, down to the individual level. But beyond the numbers, PEPFAR’s success is having a far wider reach., down to the individual level. But beyond the numbers, PEPFAR’s success is having a far wider reach.
Education and Opportunity for Youth
Healthy parents are more likely to have kids in school, access to healthcare, and opportunities for growth, stability and prosperity. The AIDS epidemic wiped out nearly an entire generation of parents in some African countries, leaving millions of orphans and vulnerable children. PEPFAR estimates that 13.4 million children are living without one or both parents due to AIDS, most in sub-Saharan Africa.
PEPFAR is supporting 6.4 million of these children with clinical and social services, and its recently released strategy includes a commitment “to provide even more services for orphans and vulnerable children.”
Empowerment of Girls and Women
Violence against young women and girls is linked with HIV. Girls and young women account for 74 percent of new HIV infections among adolescents in sub-Saharan Africa and are disproportionately the victims of sexual abuse and violence. Approximately 1 in 3 girls report an unwanted sexual experience before the age of 18.
Since PEPFAR launched its DREAMS (Determined, Resilient, Educated, AIDS-free, Mentored and Safe) p in 2014, it has reached over 1 million girls and young women, and has seen a 25 to 40 percent decline in new HIV infections in this demographic where DREAMS operates. The partnership provides critical HIV prevention services in high-burden districts to reduce the risk of HIV infection, encourage knowledge of HIV status, and ultimately to prevent the spread of HIV/AIDS. This effort to is a holistic approach to empower girls and young women with health, education and opportunity.
Democratic Stability and Economic Growth
A report on strategic health diplomacy included evidence that:
- Countries receiving PEPFAR support scored better on socio-economic indices by stabilizing human capacity
- PEPFAR enhanced security, stability, and governance
- PEPFAR countries saw a 40 percent reduction in political instability and violent activity compared to 3 percent among non-PEPFAR countries
- PEPFAR has enhanced the public opinion of the United States.
Further, the Bush Institute's call-to-action paper, The Spirit of Liberty: At Home, In the World, demonstrates how programs like PEPFAR increase global peace, security and stability.
But to protect these results, and push toward reaching epidemic control, the global AIDS agenda will have to pay attention to key considerations.
Since the height of the epidemic, people are living longer with HIV/AIDS, but their compromised immune systems leave them susceptible to AIDS-defining diseases. Saving lives from AIDS without also preventing AIDS comorbidities puts the investments made at risk. What good does it do to save lives from AIDS when people living with HIV (PLWH) can prematurely succumb to another deadly disease?
PLWH have an estimated 16 to 27 times higher risk of developing tuberculosis (TB) than people who do not have HIV. And in 2015, TB accounted for every 1 in 3 AIDS-related deaths. TB is difficult to treat, and multidrug resistant TB poses event greater challenges to the eradication of the disease. The international global health community is making new commitments to end TB, and the U.S. should recognize that ending TB protects its investment in AIDS.
When President and Mrs. Bush learned that women living with HIV are 4 to 5 times more likely to develop cervical cancer, they started Pink Ribbon Red Ribbon (PPRR), now an independent affiliate of the Bush Institute. PRRR builds on the AIDS platform and protects investments in AIDS by preventing cancer in HIV-positive women.
High risk populations, including in the U.S.
Paying attention to key high-risk populations ensures no one is left behind. Women and men under 35 are particularly vulnerable. The "youth bulge" in sub-Saharan Africa poses one of the greatest challenges to PEPFAR's progress. By 2030, youth in sub-Saharan Africa will have doubled from the start of the HIV epidemic in 1990. This is a key target population under PEPFAR’s current strategy.
Sex workers and men who have sex with men (MSM) carry a heavy HIV-burden. In many places, including the U.S., these groups are subject to increased stigmatization. Some countries have denied them access to healthcare and antiretroviral drugs. Aside from blatant discrimination, failing to focus on high risk populations only serves to perpetuate the epidemic. The CDC estimates MSM comprise 4 percent of U.S. males, but the rate of new HIV diagnoses among them is 44 times greater than other men. The U.S. must also look inwardly as we continue to lead the global fight against AIDS.
Additionally, people who inject drugs are at increased risk of contracting HIV. Globally, the WHO estimates that 13 percent are living with HIV. The recent declaration of the opioid epidemic as a public health emergency in the U.S. intensifies the link between drug injection and HIV, as opioids are often gateway drugs for injectables.
Health Systems' Holistic Strengthening
PEPFAR’s partnership approach between governments has enabled health systems to address health concerns beyond AIDS. In October, an SMU global health panel credited PEPFAR for helping Nigeria respond to the 2014 Ebola threat and avert an outbreak in the country. Still, weak health systems led to Ebola outbreaks across West Africa.
Considering the vulnerabilities of PLWH to other diseases, a continually interconnected world, and the threat of pandemic outbreak of infectious disease, addressing AIDS must continue to consider strengthening of health systems holistically. Fortifying healthcare systems ensures equitable, accessible, and affordable healthcare at all population levels.
Momentum and Funding
President Bush outlined the importance of continued U.S. leadership in the fight against AIDS. PEPFAR’S new strategy is aggressive, and full commitment from the U.S. in the global AIDS fight will be critical in maintaining momentum toward epidemic control. PEPFAR has not only saved lives but also builds good will and lifts up societies. With collective commitment and appropriate resources, we can meet the global goal of ending AIDS by 2030.
Crystal Cazier is an Associate at the George W. Bush Institute. In this role, she serves as the primary liaison for policy and programming between the Bush Institute and its independent affiliate, Pink Ribbon Red Ribbon, a global partnership fighting women’s cancers. Crystal also supports the Bush Institute’s First Ladies Initiative, and works with the performance management team on evaluation of programming across the Bush Institute.
Before joining the Bush Institute, Crystal worked as a Clinical Research Associate at the Carle Cancer Center in Urbana, Illinois where she managed budgetary and contractual negotiations for both pharmaceutical and government-sponsored clinical trials.
Crystal received her undergraduate degree from the University of Illinois in Urbana-Champaign and is currently pursuing a Master of Public Health at the University of Texas Health Science Center.Full Bio
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