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Agnes Musonda of Zambia’s Center for Infectious Disease Research meets with members of the Mphamba Village community to provide cervical cancer education.

Questioning the continued relevance of PEPFAR is dangerous thinking

November 30, 2018 5 minute Read by Crystal Cazier
17 million lives have been saved thanks to the resolve of national governments, investments by PEPFAR, and support of many. But this is not time to quit.

As graphs plot decreasing trends in new HIV infections and AIDS-related deaths globally, some may be tempted to question the continued relevance of fully sustained U.S. foreign assistance through the President’s Emergency Plan for AIDS Relief (PEPFAR). This is dangerous thinking.

PEPFAR may appear less urgent now than it was 16 years ago, a time when AIDS was a death sentence in places without proper access to treatment. But PEPFAR is no less necessary than it was when the program was born.

The history of PEPFAR demonstrates how a program built on partnership and compassion changed the course of the AIDS pandemic. President George W. Bush’s vision to work with leaders where AIDS was threatening entire communities led to the largest response to a single disease by one country. Now, thanks to the resolve of national governments, investments by PEPFAR, and support of many, 17 million lives have been saved. But this is no time to quit.

While overall HIV incidence is decreasing, rates of new HIV infection are rising in young people in sub-Saharan Africa, especially women and girls ages 15 to 24 and men under 35. Africa has the youngest population in the world; 60 percent of Africans are under age 25 and the median age on the continent is 18. Thanks to improved health outcomes including prevention of mother-to-child transmission of HIV, decreased maternal and child mortality with sustained high birth rates, and improvements in prevention and treatment for HIV, the youth population is expected to double by 2020 from the beginning of the AIDS pandemic in 1990.

Furthermore, UNAIDS recently reported 47 percent of global new HIV infections occur in key populations.

These communities need effective prevention and control strategies that reverse the upward trend and keep HIV at bay. They should be included in leading solutions that produce sustainable programming. PEPFAR’s DREAMS, MenStar Coalition, and other partnerships are examples of such programming, but Congress and policymakers need to sustain and scale up these efforts.

While HIV is no longer a death sentence, other diseases threaten those living with HIV. For instance, Tuberculosis (TB) kills more people each year than HIV and malaria combined, and people with HIV are 20 to 30 times more likely to develop TB. PEPFAR integrates prevention, diagnosis, and treatment of TB into HIV services.

Many countries in sub-Saharan Africa also face a double-burden of infectious and non-communicable diseases. For example, women living with HIV are five times more likely to develop cervical cancer. The George W. Bush Institute has partnered with PEPFAR and UNAIDS to build on the existing platform to make sure that women living with HIV receive screening and treatment. The U.S. Government should build on this work to ensure that people living with HIV do not succumb to other diseases.

PEPFAR’s investments not only prevent and treat diseases; it strengthens a country’s health care system— health information and disease surveillance systems, laboratory systems, human resources, and physical and sanitation infrastructure. Strong healthcare systems position countries to respond to health emergencies more quickly. Ebola reminds us of this.

In 2014, many sub-Saharan African countries suffered grave losses from Ebola. Former President Olusegun Obasanjo of Nigeria credited PEPFAR’s investment in health system strengthening with preventing the widespread outbreak of Ebola in his country— 19 people were infected and seven died.

Programs that invest in a country’s health system should be a top priority for Congress. Strengthening global health security only strengthens Americans’ health security. More resources should be devoted to PEPFAR and similar efforts. 

On this World AIDS Day, let’s celebrate the leadership of the United States to fight AIDS, while recognizing that PEPFAR is still highly necessary and should be funded fully. Congress and the Administration should continue engagement in global health and strengthen PEPFAR while inviting other partners to join.


Author

Crystal Cazier
Crystal Cazier

Crystal Cazier serves as an Associate 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.

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