PEPFAR’s decade-long fight against AIDS

Ten years ago, the world faced an AIDS epidemic that, each day, claimed 8,000  lives and threatened the core of many families, communities and national economies. On January 20, 2003, millions of people living with and affected by AIDS went through their daily routines unaware that hope for a brighter future would soon be renewed.

That day, in his State of the Union address, then-President George W. Bush announced the President’s Emergency Plan for AIDS Relief (PEPFAR), an unprecedented initiative to help turn the tide on AIDS. Merely three months later, a bipartisan Congress passed a bill authorizing PEPFAR, representing the largest financial commitment by any nation to combat a single disease internationally.


During its first five years, PEPFAR raced against the clock to help stem the rising tide of new HIV infections and AIDS-related deaths. Focusing on the hardest-hit countries in sub-Saharan Africa, PEPFAR moved quickly to test and counsel those at higher risk for HIV, prevent mother-to-child transmission of HIV and enroll those already living with HIV for treatment. This unparalleled mobilization of resources, both human and financial, lifted communities and countries from the darkest days of the epidemic and shined a light toward a more hopeful future.

Today, an AIDS-free generation is in sight. Landmark scientific advances and successful programmatic implementation are bringing the world to a tipping point in the epidemic. By this, I mean the point at which the number of new patients on antiretroviral treatment exceeds the number of people who are becoming infected. In the past year, a remarkable seven countries in sub-Saharan Africa have reached this tipping point — and many others will do the same in the next three to five years if we continue to strengthen and sustain our efforts. By rapidly scaling up proven HIV interventions, we are getting closer than ever before to ending the epidemic.

On World AIDS Day 2011, President Obama strengthened America’s commitment and set ambitious new goals for HIV prevention and treatment, which PEPFAR is on track to meet. Unprecedented progress has been made, building on the strong foundation laid by the Bush administration and continuing though the Obama administration with strong, bipartisan support from the Congress. In 2012 alone, PEPFAR directly supported nearly 5.1 million people on antiretroviral treatment — a three-fold increase in only four years; provided antiretroviral drugs to prevent mother-to-child transmission of HIV to nearly 750,000 pregnant women living with HIV, which allowed approximately 230,000 infants to be born without HIV; and enabled more than 46.5 million people to receive testing and counseling.

PEPFAR has enabled access to healthcare where previously little or none existed, strengthening the capacity of partner country health systems to address a broad range of issues, from maternal and child health to other diseases such as tuberculosis and malaria. By fighting AIDS, we are supporting the foundation of healthy, productive and stable societies in which countries can better care for their own people — not just today, but over the long term.

So there is great reason for hope; but the job is far from finished. According to UNAIDS, an estimated 1.7 million people are dying annually from AIDS-related causes. Moreover, global health and development resources are being squeezed due to tough economic times. While we cannot gloss over these challenges, the opportunity before us is extraordinary, and we must seize it. To do so, we need the continued commitment and leadership of partner countries, reinforced with support from donor nations, civil society, people living with HIV, faith-based organizations, the private sector, foundations and multilateral institutions.

In November 2012, PEPFAR issued a Blueprint for Creating an AIDS-free Generation, sending the unequivocal message that America’s commitment to the global AIDS response will remain strong, comprehensive and driven by science. The blueprint also outlines the critical steps the world must take — and to which PEPFAR will continue to contribute — to get many more countries hardest hit by the epidemic on the path toward achieving an AIDS-free generation.

To mark the 10th anniversary of PEPFAR’s inception, let us take a moment to recognize how far we have come in the fight against AIDS and how much closer we are to writing its final chapter. Over the past decade, PEPFAR and its many partners have created a better future for millions of men, women and children. Today, we can forge such a future for an entire generation, and we are more committed than ever to turning this promise into reality.

Goosby is the U.S. Global AIDS coordinator.