The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is one of the most successful humanitarian relief efforts ever undertaken. It is directed at one of the world's most daunting public health problems.
AIDS strikes people in the prime of their lives, shatters families and communities, orphans children, and threatens the ability of nations to develop. Bipartisan, U.S.-led efforts to address the epidemic, supported by other donor nations and the affected countries themselves, have brought health, and hope, to tens of millions of men, women and children facing AIDS.
As of this World AIDS Day, Dec. 1, nearly 21 million people living with HIV are accessing antiretroviral therapy — this is more than half of the 36.7 million people living with HIV. Of those on lifesaving treatment, 13.3 million are supported by PEPFAR.
The program has prevented more than two million (2.2 million) babies from being born with HIV. It supports more than six million AIDS orphans (6.4 million) and provided voluntary medical male circumcision to 15.2 million men and boys.
PEPFAR has made significant investments in six countries: Lesotho, Malawi, Swaziland, Uganda, Zambia and Zimbabwe. New studies show that the rate of viral load suppression among people living with HIV was more than 60 percent; by comparison, the global average for viral suppression is 44 percent.
For the first time, the latest PEPFAR data also show significant declines in new HIV diagnoses among adolescent girls and young women.
But there is a downside to such success. Remarkable progress globally, paired with advances in antiretroviral therapy, has created a dangerous misperception that the threat of HIV/AIDS is over. It is not over yet. Unless we maintain and step up our response, millions of men, women, and children who can otherwise stay healthy will suffer and die.
Effectively containing an epidemic requires constant vigilance to ensure the spread of infectious pathogens doesn’t outpace response efforts. Better data have helped pinpoint areas of unmet need and allowed us to apply resources with ever greater precision, speed and efficiency. Many more people have been reached even with flat budgets.
But the unmet need is substantial and cannot be addressed with current resources. Maintaining our momentum and continuing to scale up prevention and treatment efforts is essential to avoid being outrun by the epidemic.
While many have been reached, another 15.7 million people living with HIV including 1 million children don’t have lifesaving medicine. One million adults and children still die each year from AIDS. Despite advances in prevention, there were 1.8 million new infections in 2016.
We are still a considerable way from achieving the fast-track targets that the Joint United Nations Programme on HIV/AIDS (UNAIDS) proposed, and the world embraced, in 2015. These targets call for 90 percent of all people living with HIV being diagnosed, 90 percent of all who are diagnosed on treatment and 90 percent of all on treatment virally suppressed and a 75 percent reduction in new HIV infections — by 2020. Meeting them would reduce the rates of illness, death and new infections to levels that create the stepping stones to end the AIDS epidemic.
We must strengthen political and financial commitments to continue our work with real urgency. Greater investments must be made to foster innovation and ensure that new diagnostic, prevention, and treatment tools get to the field as rapidly as possible.
To put the world on course to ending AIDS as a public health threat by 2030, UNAIDS estimates that U.S. $26.2 billion will be needed in 2020; this is US$ 7 billion more than is currently being spent. It is not the responsibility of the U.S. alone to close the funding gap. We need powerful leadership on this issue in many nations, especially in countries affected by AIDS.
But if the U.S. — the nation that has demonstrated the greatest leadership and commitment of resources in the fight against AIDS — reduces its investment at the precise moment when efforts need intensifying, it sends the message that America is not committed to the global effort to defeat the AIDS epidemic.
PEPFAR must be fully funded; U.S. contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria must be maintained. Failure to fully fund these programs could stall our momentum and result in deadly consequences.
This is a particularly critical moment to stay engaged. There are several important biomedical innovations on the horizon with great potential to accelerate progress. When these new tools are introduced—some perhaps as early as 2020—they will dramatically improve our ability to stop AIDS. Long-lasting injectable antiretroviral treatment is currently in human clinical trials.
Administering medicine through periodic injections (as opposed to daily pills) makes it easier for people to adhere to treatment and help them achieve viral suppression, which prevents transmission of the virus. Broadly reactive neutralizing antibodies are demonstrating great promise for prevention. In South Africa, the first new HIV vaccine efficacy study in seven years—HVTN 072, involving a new version of the only HIV vaccine candidate ever shown to provide some protection against the virus—is underway. Even a partially effective vaccine could play a significant role in reducing the number of new infections.
Other evolutions, like offering the newest, most tolerable medicines at affordable prices in Africa, such as the recent agreement to sell the first, generic, single-pill HIV treatment regimen containing dolutegravir (DTG) to public sector purchasers in low- and middle-income countries (LMICs) at a cost of around $75 per person, per year — will also speed the work.
It is an especially critical time to invest robustly in research, to plan ahead for the dissemination of these exciting new tools and to find ways to get the best options for prevention and care to the greatest number of people at the lowest cost.
PEPFAR was created in a moment when little was known about how to stop the AIDS epidemic. Today, we know what to do, how to do it, and where it needs to be done. We have the medicine, the prevention tools and the international cooperation required to tackle this global health challenge. All that stands now between the possibility and the reality of ending AIDS is the determination of today’s leaders.
Former Senate Majority Leader Bill Frist, M.D. is a cardiothoracic surgeon and founder of Hope Through Healing Hands. Michel Sidibe is the executive director of UNAIDS and Under Secretary-General of the United Nations. You can find him on Twitter: @MichelSidibe.