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PEPFAR Changes the Equation
One year ago, President and Mrs. Bush traveled to Botswana and Namibia, where they visited clinics offering HIV services and cervical cancer screening and treatment. The trip overall celebrated how far the world had come in rolling back AIDS – a disease that once threatened to wipe out an entire generation across the second largest continent, with the second largest population, in the world. When President Bush launched PEPFAR, 30 million people in Africa were living with AIDS, but only 50,000 people had access to life-saving treatment.
Today, PEPFAR has put 13.3 million people on treatment and has helped 2.2 million babies take their first breaths free of HIV. In 2015, PEPFAR launched DREAMS, a public-private partnership targeting adolescent girls and young women, a demographic particularly vulnerable to HIV. Since then, new HIV diagnoses have declined 25-40% in the countries where DREAMS operates.
Last year, President Bush called for continued full funding of PEPFAR. And this year, despite concerns over deep cuts to global health funding, Congress flat-lined funding for PEPFAR, signaling its enduring support for the program.
Several countries in sub-Saharan Africa are on the verge of epidemic control – the point where new HIV infections fall below the number of deaths among people living with HIV. PEPFAR’s strategy through 2020 focuses on advancing 13 African countries to this key milestone.
As people with HIV live longer, they remain susceptible to infectious diseases, including HPV, which causes nearly all cases of cervical cancer. PEPFAR is working with Pink Ribbon Red Ribbon to increase focus on cervical cancer for women living with HIV. In its 2018 guidance memo, PEPFAR instructed countries to scale up cervical cancer screening and treatment programs to prevent HIV-infected women from needlessly dying of cervical cancer. Because women living with HIV are five times more likely to develop cervical cancer, this collaboration between PEPFAR and PRRR is another success worth celebrating.
In just one year, PEPFAR has documented incredible progress. PEPFAR measures its effectiveness using granular-level data, ensuring tax payer dollars are well-spent and identifying areas in need of additional support.
Despite progress made against HIV, key populations are falling behind. Adolescent girls and young women (AGYW) account for 74% of new HIV infections among young people in sub-Saharan Africa. Men are lagging behind in testing and unknowingly infecting their partners with HIV. The International AIDS Society reports that 44% of global new HIV infections are occurring in men who have sex with men, people who inject drugs, sex workers, and transgender individuals. Another challenge is the rapidly rising HIV incidence in Eastern Europe. In 2016, 80% of HIV diagnoses in Europe were in Eastern Europe. If we want to end AIDS by 2030, we must include all people in our efforts to provide life-saving services.
The progress made in the fight against AIDS is worthy of celebration, and PEPFAR’s contribution to the shift in the pandemic is undeniable. The end of AIDS is now a real possibility, a fact that may have seemed impossible 15 years ago. We’re on the right track, but if we stop now, we put progress at real risk. Substantial progress has been made, but we must also be cognizant of the need to progress in areas where gaps remain.
Crystal Cazier serves as Program Manager for the Global Health Initiative and for Evaluation and Research at the George W. Bush Institute. In this role, she helps coordinate the Bush Institute’s involvement in The Partnership to End AIDS and Cervical Cancer, a collaboration of the Bush Institute, PEPFAR, and UNAIDS that works with eight countries in sub-Saharan Africa to prioritize HIV-positive women in national cervical cancer prevention and control programs. She also serves on the research and evaluation team which supports programming across the Bush Institute.
Before joining the Bush Institute, Crystal worked as a Clinical Research Associate at 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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