This World AIDS Day, as we approach the fortieth anniversary of the first reported cases of AIDS, it is breathtaking to reflect on how far we have come and how far we still need to travel together, as a global community, in saving and improving millions of lives touched by the pandemic. Over the past 18 years, with strong bipartisan leadership across multiple U.S. presidencies and U.S. congresses, and the incredible generosity of the American people, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has helped transform the HIV response from crisis toward control.
Where AIDS once meant unfathomable death and despair, there is now vibrant life and hope. The figures speak for themselves – 20 million lives saved, millions of HIV infections prevented, and the AIDS epidemic being controlled in a growing number of countries – but the numbers cannot fully capture the magnitude of what the U.S. government has accomplished through PEPFAR, working in close partnership with countries and communities around the world.
This year, some of the first babies born HIV-free with PEPFAR support started college. Millions of parents living with HIV have been healthy to nurture, protect, and teach their children along their journey to adulthood. Countless aunts, uncles, grandparents, cousins, and friends remain alive to enrich the next generation with their wisdom, support, and love. While our work is not yet done, PEPFAR has unequivocally made the world a safer and more secure place from HIV and other health threats.
Through smart investments and critical policy changes driven under the PEPFAR Strategy for Accelerating HIV/AIDS Epidemic Control (2017-2020), several PEPFAR-supported countries have now achieved HIV epidemic control nationally, a goal that appeared unimaginable even a decade ago. A series of countries have also attained or exceeded the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets, a critical milestone toward reaching the Sustainable Development Goal 3 target of ending the AIDS epidemic as a public health threat by 2030.
As of September 30, 2020, PEPFAR supports 17.2 million men, women, and children with life-saving antiretroviral therapy—50 percent more than just four years ago. The program continues to prevent millions of HIV infections through comprehensive interventions, including those enabling babies to be born HIV-free to mothers living with HIV, empowering adolescent girls and young women, innovating to reach young men, and serving key populations at higher risk for HIV infection.
PEPFAR’s latest results also demonstrate the program’s unmatched capacity to help protect and advance HIV gains, even in the face of severe adversity. This year, the COVID-19 pandemic has challenged us all in unprecedented ways. While PEPFAR and partner programs have shown remarkable resilience in the context of COVID-19, its impact on HIV, tuberculosis (TB), and malaria prevention programs has been devastating. These programs were among the first and hardest-hit by COVID-19, and the pain has been particularly acute for women and children as well as other vulnerable and marginalized populations.
The dual HIV and COVID-19 pandemics continue to reveal and exacerbate existing inequities and vulnerabilities in societies around the globe. The HIV gains that we were making together as a global community are especially at risk and we will need increased investment in HIV prevention programs to restore these gains, notably for young women and key populations. This year has also shown the vulnerability of prevention programming in the public sector, which may require rethinking how we strengthen public sector health care by increasing our investment in community-based service delivery through peer organizations.
COVID-19 has also exposed the fragility of health care systems in some middle- and upper-income countries, including many in Eastern Europe, Asia, and Central and South America, which due to their relative wealth have lost their GAVI and Global Fund eligibility, along with the significant support previously available via Global Fund mechanisms. These factors, combined with losses in economic productivity, will impact affected countries’ ability to access COVID-19 vaccines once they are available, and will further marginalize critical key populations. As a global community we will need to address these inequities in new ways that ensure sustainability of all programming.
We must overcome these obstacles swiftly and decisively to sustain – and in some cases regain – hard-won progress against HIV, TB, and malaria. We must ensure that people are not faced with an impossible choice between food and health care. The economic devastation from COVID-19 and its worldwide impact on health programming and access must be dealt with comprehensively. We must ensure that our investments reach the most vulnerable where they are with what they need. And we must ensure that country and community health care systems are enduring, responsive, and resilient – capable of contributing to pandemic response and global health security for years to come. I have every confidence that the challenges laid bare by the COVID-19 pandemic can and will be addressed as we work together in solidarity.
Through the more than 3,000 laboratories, 28 national reference laboratories, and 70,000 health care facilities that we support, and the nearly 290,000 health care workers that we have trained around the globe, PEPFAR is uniquely positioned and deeply committed to help confront these challenges head-on. But it will take all of us, pulling together, to ensure we get back and stay on track.
On this World AIDS Day, despite the many challenges facing our world, we also have many reasons for optimism and hope. More countries than ever have achieved or are approaching HIV epidemic control. Twenty-six million men, women, and children living with HIV are on life-saving antiretroviral treatment. We continue to make important strides in HIV prevention, including for adolescent girls and young woman.
As we approach a fifth decade of the AIDS epidemic, we must continue to push – honoring the millions of precious lives we have lost and fighting for the lives of the millions more who are still with us. Ending AIDS remains one of the great tests of our time – and I know that we can succeed.