PEPFAR: Achieving an AIDS-Free Generation
The President’s Emergency Plan for AIDS Relief (PEPFAR) is a program that was born from bipartisan legislation in 2003 under George W. Bush’s administration. It was the biggest global health investment for a single disease by any country in the world, and still is today. We sit down with Caitlin Horrigan from Planned Parenthood Federation of America to discuss the evolution of PEPFAR, the ways in which it has provided care for HIV/AIDS patients around the world, and the attacks it is now facing from the Trump administration.
In 2002, HIV/AIDS was the leading cause of death of people between the ages of 15 and 59. Fear, stigma, and misinformation, undermined work on HIV/AIDS and, while treatment options were available, they were available only in certain locations. Millions of people were needlessly dying due to lack of resources, and an HIV/AIDS diagnosis seemed to be a death sentence.
But in 2003, George W. Bush’s administration, with bipartisan support, established PEPFAR in order to address this public health emergency. It started as a $15 million five-year plan to combat HIV/AIDS, malaria, and tuberculosis on a global scale. Originally focused in fifteen countries, PEPFAR now impacts over forty. The program delivered necessary emergency care to those who needed it; bringing treatment to those with HIV/AIDS, preventing mother-to-child transmission, and helping build medical infrastructure in countries that lacked in HIV/AIDS prevention methods.
PEPFAR expanded even farther under the Obama administration- the global financial crisis heavily limited funding, but forced the administration to think outside the box in order to make programs more effective. Women and adolescent girls became a major focus of global health programs and PEPFAR in particular. The administration created the DREAMS (Determined, Resilient, Empowered, Aids-Free, Mentored and Safe) Initiative, a groundbreaking new initiative focusing on HIV/ADIS prevention for adolescent girls and young women mostly in sub-Saharan African countries in a cross-sectoral fashion. This program was desperately needed; 1,000 women and young girls are newly infected with HIV every day, and it is a disproportionate amount.
Since the transition into the Trump Pence administration, there have been dramatic cuts to global health at large, and this includes HIV/AIDS. Also affecting progress on HIV/AIDS the Trump Pence administration has been attacking issues that intersect with HIV/AIDS like sexual and reproductive health, emergency contraception, and sex education.
The Global Gag Rule used to only apply to family planning and reproductive and sexual health, but the administration has expanded it to apply to all of global health-- including HIV/AIDS (for more general information on the Global Gag Rule, check out episode five of RePROsFightBack). Providers are holding back on administering services that are needed due to confusion and fear. In Mozambique the International Planned Parenthood Association has lost about two thirds of their budget due to the expanded Global Gag Rule. The program supports about 500,000 people, including young people, who have HIV/AIDS or were newly diagnosed.
We can’t leave anyone behind in the HIV/AIDS community. If we truly want to achieve an AIDS –free generation, we can’t leave women and girls, LGBTQ+ populations, sex workers, people who use drugs behind. There’s no one-size-fits-all solution, but we have to find a solution to deliver. PEPFAR is the first step.