It started as a five-year, $15 billion promise by President George W. Bush. Seventeen years later, it is now the world’s largest campaign to fight HIV and AIDS in the history of the disease, with over $85 billion having been committed to fighting this condition.
Since its announcement in 2003, the President’s Emergency Plan for AIDS Relief has saved approximately 18 million lives through the provision of medicine and the care of patients diagnosed with HIV/AIDS. Funding currently reaches over fifty countries.
This success has yielded bi-partisan support, with the program receiving re-authorization four separate times, in 2008, 2013, 2018, and most recently in December 2019.
For the 38 million people living with HIV around the globe, PEPFAR has been an indispensable lifeline, specifically in developing countries where access to care is limited or medicine is financially out of reach.
In 2009, a group of American doctors traveled to Vietnam to set up a partnership with Vietnamese medical centers to better provide treatment for AIDS patients. Five years prior, Dr. Thuy Le of the University of Hawaii medical school claimed that in Vietnamese hospitals, “HIV was a death sentence”. Due to the disease’s stigma, many doctors neglected their patients and innovative treatments had not been introduced to most communities.
Following the establishment of this partnership between the two countries’ medical communities, PEPFAR provided medicine that was previously unavailable due to cost constraints. As reported by VietnamInfo, the drugs they supplied would normally cost about $50 per month, an unrealistic expense for the average Vietnamese who made just over $100 per month at the time.
Despite its positive impact, PEPFAR has its critics. Alex Kentikelenis, a social scientist from Oxford, finds fault with the way the program is carried out, “PEPFAR funding for combating HIV overwhelmingly went to American NGOs. Only circa 11% (goes) to developing country governments.”
Another common criticism is PEPFAR’s abstinence campaigns. Specifically, a third of the money going toward the program’s HIV prevention was originally allocated to abstinence programs.
“For all of the good that PEPFAR has done, such restrictions have compromised the health and human rights of the law’s intended beneficiaries — women and girls, in particular,” says Sierra Sippel, President of the Gender Health organization, CHANGE.
According to the National Public Radio, the US has spent more than $1.4 billion to establish abstinence programs in Africa. Despite this unprecedented funding, a study by the Kaiser Family Foundation, a health and policy non-profit, found that abstinence programs are not associated with a reduction in HIV risk behavior in Africa. Other studies have found similar results.
Many are far less skeptical. “PEPFAR is hard to criticize. It is a landmark victory against a terrible disease, and a shining obelisk inscribed with the message that humans can work together for the common good. PEPFAR’s flaws have little to do with the program itself, but in what occurs outside the program’s four walls,” says Daniel Aaron of Harvard University. Aaron is not alone, PEPFAR is widely considered one of the most successful public health initiatives ever undertaken.
PEPFAR currently provides 14.6 million people with life-saving treatment, with a significant portion of these patients living in Africa. Before PEPFAR’s inception, only 50,000 people were on treatment in Sub-Saharan Africa.
As the program was recently reauthorized for an additional $300 million in the new federal budget, PEPFAR will continue to provide indispensable healthcare for years to come.