FHI360 IS PROUD OF PEPFAR
On World AIDS Day, GAPP members share why they are so proud of PEPFAR’s and what they envision for its future. Below, read why Dr. Christopher Akolo, Technical Director at FHI 360 is proud of PEPFAR.
PEPFAR is widely recognized as a shining example of U.S. global leadership and bipartisanship. Can you tell us, in your opinion, why this is?
Since its inception in 2003, PEPFAR has consistently received strong bipartisan support from both Republican and Democratic administrations and Congress. While this unity across political lines may be rare in U.S. foreign policy, it highlights the shared commitment to combating HIV as a global humanitarian issue, rather than a political one.
PEPFAR has saved millions of lives and transformed global efforts in HIV prevention, care, and treatment, especially in countries where, without it, millions more would have died. By investing in building health systems, PEPFAR has helped to dramatically reduce HIV transmission rates and AIDS-related deaths, especially in high-burden countries.
The measurable, life-saving results have reinforced PEPFAR’s status as a successful and impactful program. Furthermore, PEPFAR’s emphasis on partnerships with governments, civil society, and multilateral organizations—such as UNAIDS— has enhanced the U.S.’s reputation as a global health leader. In the countries where PEPFAR is implemented, people know that this support comes from the American people.
Finally, the efforts of the U.S government through PEPFAR have shown how sustained commitment and collaboration can tackle major global challenges.
Can you give us an example of PEPFAR’s work in a country or community that highlights its impact?
PEPFAR has had a transformative impact in many countries and communities, particularly in sub-Saharan Africa, where the burden of HIV is highest. An example that highlights PEPFAR’s significant contributions, and the difference it has made on the ground, is the story of Eswatini (formerly known as Swaziland).
Eswatini is one of the first countries to reach the UNAIDS’ 95-95-95 targets (95% of people living with HIV know their status, 95% of those diagnosed are on treatment, and 95% of those on treatment have viral suppression). This was a remarkable achievement for a small country that once had one of the highest HIV prevalence rates in the world. PEPFAR, through its partners, played a critical role by supporting the scale-up of HIV testing and treatment strategies targeting populations with an increased risk of HIV. The test-and-treat approach ensured that anyone diagnosed with HIV is immediately linked to antiretroviral therapy (ART), which reduces viral load and prevents further transmission. As a result of PEPFAR’s efforts, the number of new HIV infections in Eswatini decreased significantly, and AIDS-related deaths dropped by more than 50%.
The successful implementation of these initiatives has set an example for other high-burden countries in the region. This example illustrates PEPFAR’s immense contribution to reducing the global burden of HIV, saving millions of lives, and supporting sustainable health system improvements.
Why do you think it’s so important for the U.S. to play such a significant role in the global HIV/AIDS response?
The world is now a global village; no country can live in isolation. The U.S. has a vested interest in preventing the spread of infectious diseases, such as HIV infection, which can destabilize communities, economies, and global health security. By leading the response, the U.S. helps contain the epidemic before it becomes a larger global health crisis, protecting both the world and its own citizens, from potential future outbreaks.
Secondly, involvement of the U.S. demonstrates humanitarian leadership and moral responsibility. The U.S. has a longstanding humanitarian commitment to saving lives and improving health outcomes in vulnerable populations across the world. HIV disproportionately affects low-income countries, particularly in sub-Saharan Africa, where healthcare resources are limited. As a global leader, the U.S. has the resources and expertise to significantly impact the health and well-being of millions of people, who might not otherwise have access to life-saving treatment and prevention services.The global fight against HIV is not only a health issue but also a moral one. I believe that, as a wealthy nation, the U.S. has a responsibility to contribute to solving global challenges, particularly when many lives are at stake.
Through programs like PEPFAR, the U.S. strengthens its diplomatic relationships with other countries by investing in their health systems and improving the quality of life for their citizens. These ties build goodwill, foster collaboration, and enhance U.S. influence globally.
Furthermore, the U.S. is a global leader in medical research and innovation, which has been critical in developing life-saving antiretroviral treatments and advancing new prevention technologies like pre-exposure prophylaxis (PrEP). By playing a central role in the HIV/AIDS response, the U.S. helps accelerate the development of new tools and strategies that can be used worldwide.
Finally, PEPFAR is widely recognized as one of the most successful and impactful global health initiatives. The U.S. has shown that it is possible to make tangible progress against even the most devastating global health crises with sustained leadership and investment. Therefore, the U.S.’s leadership not only saves lives but also strengthens global health systems, reinforces its position as a leader in global health, and protects its own national interests.
What makes PEPFAR so effective? What lessons from PEPFAR can we apply to other global health challenges?
PEPFAR’s effectiveness can be attributed to several key factors that make it a model for other global health initiatives. These factors include use of data-driven approaches, strong and effective leadership, adaptability, and a commitment to partnerships. It is important to state that many of these lessons can be applied to solving or addressing other global health challenges.
PEPFAR uses a rigorous, data-driven approach to monitor and evaluate its programs. Real-time data collection and analysis enable PEPFAR to identify gaps, adjust interventions, and ensure resources are used effectively. This results-based approach ensures that the program remains efficient and impactful. By leveraging data, PEPFAR can prioritize high-prevalence countries, specific populations, and interventions that will have the greatest impact on reducing new HIV infections and improving patient outcomes. This approach can be applied to combat other diseases like malaria, non-communicable diseases, and emerging pandemics.
Since PEPFAR was launched in 2003, it has enjoyed bipartisan support. This consistent political will has ensured sustained funding, accountability, and long-term planning. This type of high-level leadership, as well as political commitment and clear goals are essential for any global health program to be successful.
Over the years, PEPFAR has shown remarkable flexibility in adapting to changing circumstances. For instance, it has shifted from an emergency response to a long-term, sustainable approach. It has expanded its focus to include key populations who are disproportionately affected by HIV, strengthened health systems, and integrated HIV services into broader primary healthcare frameworks. During the COVID-19 pandemic, PEPFAR demonstrated adaptability by integrating COVID-19 responses into existing HIV programs. This included shifting service delivery to community-based models, multi-month dispensing of antiretroviral drugs, and leveraging existing PEPFAR infrastructure for COVID-19 testing and vaccination. Global health programs must be designed with flexibility to adapt to new health threats and changing circumstances. Whether it’s responding to an emerging pandemic or addressing the rise of NCDs, adaptability is key to maintaining progress. Programs should be prepared to integrate new tools, technologies, and approaches as needed.
Partnerships are key to PEPFAR’s success. The program works closely with local governments, civil society, multilateral organizations, and the private sector to build partnerships that support PEPFAR’s goals. These partnerships have been instrumental in scaling up HIV prevention, testing, and treatment efforts in resource-limited settings. For global health programs to be effective, they should prioritize partnerships with local stakeholders, including governments, healthcare workers, and communities. Building local capacity and infrastructure ensures that programs are sustainable in the long term and can continue even after external funding decreases. This sustainability is essential in addressing health challenges like maternal and child health, tuberculosis, and infectious diseases.
What would you tell people who say that we shouldn’t be focusing on one single disease area at this level when there are so many other global health challenges?
In terms of scale, HIV remains one of the deadliest pandemics in modern history; over 40 million people living with the virus, and millions more at risk of infection, especially if the proven interventions for preventing new infections are not quickly scaled up. HIV disproportionately affects low- and middle-income countries, particularly in sub-Saharan Africa, where healthcare systems are often already overburdened.
A focused response on HIV is essential; leaving such a widespread epidemic unchecked has far-reaching consequences. It weakens entire societies, increases healthcare costs, affects economic productivity, and exacerbates poverty, making it harder for countries to tackle other health challenges. Therefore, investing in HIV is an important aspect of global health security.
Additionally, PEPFAR’s work has gone beyond just HIV prevention, care, and treatment. It has contributed to the strengthening of entire healthcare systems. Investments in laboratory infrastructure, supply chains, human resources for health, and surveillance systems improve the overall capacity of health systems to respond to a wide range of diseases and public health needs. HIV programming is also increasingly integrated with other health services, making these programs a platform for addressing multiple diseases in an efficient way. This integration ensures that resources are used more effectively across health priorities. Addressing HIV/AIDS is a matter of equity and social justice; it ensures that the most vulnerable populations are not neglected. The lessons learned from combating HIV can be applied to reducing health inequities in other areas as well.
This past spring, PEPFAR was reauthorized for 1 year. Typically, it receives a 5-year reauthorization. Why is a multiyear reauthorization necessary?
While the one-year reauthorization this past spring ensured short-term continuity, a longer commitment is critical for the program’s success and sustained impact. For example, a multiyear reauthorization provides predictability for PEPFAR’s implementing partners, governments, and stakeholders, allowing them to plan and execute long-term strategies. HIV is now a chronic and manageable condition that requires continuous treatment, monitoring, and prevention efforts. Health programs, particularly those focused on ensuring and maintaining viral suppression and prevention, need stability to ensure treatment continuity and to avoid interruption in treatment.
Many of the PEPFAR-supported initiatives—such as differentiated HIV testing, expanding treatment access, reducing mother-to-child transmission, and strengthening health systems—require several years of consistent funding and strategic scaling to achieve meaningful impact. A five-year reauthorization allows PEPFAR to plan and execute these initiatives effectively. It also helps ensure additional commitments from other donors, multiplying the overall impact of the response. Many of the health outcomes, such as viral suppression rates and reduction in new HIV infections, are achieved through such long-term, sustained efforts.
Short-term reauthorizations lead to uncertainty, making it harder for partners to invest in, and commit to, long-term initiatives. For example, PEPFAR’s work involves large-scale procurement of ARVs, HIV testing kits, and laboratory commodities. Supply chains for health products operate on multiyear procurement cycles. A one-year reauthorization complicates these logistics and may disrupt supply chains, leading to shortages of critical commodities and risking treatment interruptions for millions of people.
PEPFAR invests in building laboratory systems, data management systems, and workforce training, all of which require ongoing support. These systems and infrastructure take years to establish, and multiyear funding is necessary to ensure their sustainability and effectiveness over time. Additionally, multiyear reauthorization enables better financial planning, cost savings, and operational efficiency, ensuring that every dollar goes further in the fight against HIV/AIDS. Finally, multiyear reauthorization is critical for maintaining momentum in achieving global HIV/AIDS targets and ensuring that decades of progress are not reversed.
If you could tell U.S. decision makers one thing about why you are proud of PEPFAR, what would it be?
PEPFAR has saved over 25 million lives globally and it has turned the tide of one of the deadliest diseases in human history. This success is a testament to the power of compassion, leadership, and sustained global commitment. Through PEPFAR, the U.S. has not only led the fight against HIV but has also strengthened healthcare systems, empowered communities and groups, and fostered hope in places where despair once prevailed. It is an accomplishment for which the American people can be very proud.