Health Expert Voices: Reflections on 20th Anniversary of PEPFAR

PEPFAR – or the U.S. President’s Emergency Plan for AIDS Relief – was conceptualized by Dr. Anthony Fauci in 2003 after a White House meeting with then President George W. Bush who challenged him to think big. Over the last twenty years, PEPFAR has invested more than $100 billion in the global HIV/AIDS response, effectively saving 25 million lives, preventing millions of new HIV infections, and serving as a platform that has helped to combat avian flu, Ebola, and – more recently – COVID-19. 

Growing up in the 80s and 90s, I heard horrifying stories of kids losing their parents and it made such an impact that once I completed my Epidemic Intelligence Service Training at the CDC in 2008, I began my career working in PEPFAR, including roles at the CDC and USAID.  

Today, I was fortunate to attend a World AIDS Day event, sponsored by PEPFAR and the Business Council for International Understanding (BCIU), which honored Dr. Fauci for his decades-long commitment to ending the HIV/AIDS epidemic. The event was a powerful reminder of what is possible when humanity comes together to fight a global threat.  

Below are some of the big takeaways:  

In his opening remarks, Dr. Fauci reflected on the horrifying days when there was no treatment available and those with HIV were desperately looking for answers as people were dying left and right. And when there was finally a treatment available, it required a grueling 28 pills per day regimen. Today, in contrast, those with HIV can live healthy lives with just one pill a day. And, we have made major strides in transmission reduction, thanks to the success of the U=U – or “undetectable equals untransmittable” – breakthrough of reducing viral load in HIV+ patients, in addition to pre-exposure prophylaxis (or PrEP) – now available as both a daily pill and a long-acting injectable. What remarkable reminders of the progress we’ve made in this fight. 

While Dr. Fauci spoke excitedly about progress, though, he also warned, “Success leads to complacency.” He said that while the tools are available, implementation and access remain a concern.  

Dr. John N. Nkengasong, the U.S. Global AIDS Coordinator and Special Representative for Health Diplomacy, spoke fondly of his days working as a virologist in the early days of HIV/AIDS when he’d seek out Dr. Fauci’s talks since there were no books on the topic, warmly acknowledging the important role that Dr. Fauci has played as a global mentor for the hundreds and thousands of HIV clinicians and researchers.  

With regards to the correlation between COVID-19 and HIV/AIDS, Dr. Nkengasong said that his experience with HIV/AIDS helped him to respond to COVID-19 in his role leading the Africa CDC. He remarked on how COVID-19 has created opportunities for an adult vaccination platform that was nonexistent before. Dr. Fauci shared that while an HIV vaccine has not yet been successful, those learnings contributed to the successful development of COVID-19 vaccines. And now, the COVID-19 vaccine’s mRNA platform is opening new doors for HIV vaccine efforts. 

Secretary of State Antony J. Blinken spoke to the game changing role that PEPFAR has played in global history, while acknowledging the role of the collective global health community – doctors, researchers, implementers, and more – coming together to save lives. He also reminded the audience that more work needs to be done around inequitable access for children, adolescent girls and young women, and vulnerable populations such as female sex workers and those who identify as LGBTQI+. 

In his response to the future of PEPFAR, Amb. Nkengasong discussed how other health concerns like mental health and hypertension can be easily integrated in PEPFAR efforts. He also reminded us that HIV still remains highly stigmatized in communities around the globe and that those affected with HIV need mental health support as part of their treatment. He wrapped up by reiterating the importance of treatment and prevention as we fight to end AIDS by 2030.  

Today’s event was an important reminder of why I do this work. PEPFAR remains the largest commitment by any nation to fight a single disease, thanks to the generosity of American people. To date, PEPFAR has made huge strides in epidemic control, including the birth of more than 5.5 million HIV-free babies, comprehensive HIV prevention services for 2.9 million adolescent girls and young women, and life-saving anti-retroviral treatment for the over 20 million women, men and children living with HIV.  

As PEPFAR starts its new phase under the leadership of Amb Nkengasong, Project HOPE is proud to continue to act as a PEPFAR implementing partner in sub-Saharan Africa. As part of PEPFAR’s reauthorization, we are hopeful that PEPFAR will prioritize HIV prevention for adolescent girls and young women, provide holistic care for those living longer with HIV/AIDS, and further leverage its existing platforms for emerging diseases and other global threats, such as climate change.   

– Dr. Nagesh Borse, Deputy Chief Health Officer

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