Member Spotlight: The George W. Bush Institute
The Global AIDS Policy Partnership is made stronger by the contributions of each one of our 70+ members. As part of our ongoing Member Spotlight blog series, we recently interviewed Hannah Johnson, the Program Manager of Global Policy at the George W. Bush Institute. Read what Hannah shared with us below.
Can you tell us a bit about your organization?
The George W. Bush Institute is a nonpartisan organization that works to ensure opportunity for all, strengthen democracy, and advance free societies through policy solutions and public engagement.
Can you describe your organization’s involvement with the HIV response?
The Bush Institute is guided by the legacy established by President and Mrs. Bush while they were in office. I believe the President’s Emergency Fund for AIDS Relief (PEPFAR) is one of the cornerstone successes of that time. President Bush launched PEPFAR in 2003 with the support of Congress and the American taxpayers. At the time, he described it as a program of compassion, and we believe that’s still true today.
In 2003, HIV was spreading rapidly throughout the African continent. It was impacting primarily young, working-age people—the most productive members of society. Countries were losing large portions of their workforce, children were losing their parents, and many babies were being born already infected with HIV. It was catastrophic.
PEPFAR completely changed the trajectory of the HIV epidemic in Africa. The program partnered with civil society, national governments, communities, and faith-based initiatives to create a whole-of-society approach to combat new HIV infections and provide treatment to people who were HIV-positive. Since then, PEPFAR has saved over 25 million lives, making it the largest program to fight one single disease.
At the George W. Bush Institute, we’re proud to support PEPFAR, and we know the work needs to continue because the fight isn’t over yet. We have not ended HIV as a public health threat. We also like to see how other programs can learn from PEPFAR and implement those lessons into their own strategies. We encourage other programs to work with local communities, use data and metrics to drive programming, and promote transparent reporting. These are just a few of the strategies that have made PEPFAR so successful.
You mentioned that lessons learned from PEPFAR’s progress against HIV/AIDS can be implemented in other contexts. Can you expand on that?
First, the health infrastructure and systems PEPFAR utilizes were established in partnership with national governments, civil society, and the private sector. That means we now have an opportunity to integrate those systems into the primary health sector, and other programs have already found value in utilizing the infrastructure established by PEPFAR.
The Go Further program is a notable example of this. The George W. Bush Institute, UNAIDS, and PEPFAR work together to provide cervical cancer screening and treatment services for women living with HIV. Women who are HIV-positive are up to six times more likely to develop cervical cancer, so integrating these services with PEPFAR was an obvious choice.
Implementing cervical cancer services through the systems and partnerships established by PEPFAR has been instrumental in Go Further’s overall success. Since 2018, the program has delivered more than 7 million cervical cancer screenings for women living with HIV in sub-Saharan Africa.
We’ve also found that countries receiving PEPFAR support are more likely to have stable democracies, sustainable economies, and a higher opinion of the United States. What happens abroad matters here at home, and this shows us that PEPFAR can influence national security by helping the U.S. build diplomatic relationships.
What are you most proud of when it comes to progress against HIV/AIDS?
I would point to the sheer impact of PEPFAR. People tend to forget what HIV looked like 20 years ago. HIV was viewed as a death sentence, and entire communities were under threat.
Today, the average age of people living in Africa is 19 years old. PEPFAR turned 21 this year. Those first babies who were born HIV-free thanks to PEPFAR are now part of the generation that makes up the backbone of the African continent. They’re young adults holding the future in their hands. Some of the world’s fastest growing economies exist in Africa. In the coming decades, a third of the global working-age population is expected to be African.
The impact PEPFAR has had in Africa cannot be overstated. When you say “PEPFAR,” there’s not a person in Africa who doesn’t know what the program is. The continent looks completely different than it would have without PEPFAR.
What do you see as the greatest challenge we still face against HIV/AIDS?
We’re just five years short of the 2030 goal to end HIV as a public health threat. Some countries have met their goals, some countries have a little further to go, and some countries are not even close. Our greatest concern is sustaining PEPFAR’s success long-term.
We need to ensure that we not only end HIV as a public health threat, but also that countries remain focused on the epidemic and that communities have a seat at the decision-making table. Some countries are already working alongside UNAIDS to create sustainability roadmaps to make sure that they’ll have the tools necessary to continue their programs and integrate other issue areas after 2030.
Each nation’s private sector and civil society community must also hold their governments accountable. They need to keep calling for long-term support for HIV. It really requires a whole-of-society approach.
Could you share a story from your work that demonstrates the significance of PEPFAR?
I had the pleasure of going to Namibia last year with PEPFAR and UNAIDS for our Go Further program. I met a nurse named Lisondry Haoses. She is one of the only nurses in her region who’s trained to perform visual inspection with acetic acid (VIA) screening for precancerous lesions.
On some days, Lisondry travels 100 miles to see patients and to educate women on why they need to be screened for cancer. She noted the importance of PEPFAR in allowing her to be able to do this work. Without PEPFAR she wouldn’t be able to travel to these areas and these women wouldn’t be screened. Lisondry’s dedication to ensuring women have access to those resources is a testament to how important this work is.
In 2024, PEPFAR was re-authorized for one year. Why do you believe a multi-year reauthorization is necessary?
We don’t have a lot of time to reach our 2030 goals. A clean, five-year reauthorization of PEPFAR would ensure our continued partnership with these countries through 2030, and it would require transparent reporting so that we know exactly where we are in terms of progress. It would also demonstrate continuous bipartisan support for PEPFAR, which is so crucial right now. It demonstrates our commitment to partners countries.
Africa is a continent that’s destined for exponential growth in the coming years. Support from programs like PEPFAR is more important than ever to maintaining our diplomatic relationships and combatting authoritarian regimes.
Why is it important for your organization to be a member of the GAPP?
As I’ve mentioned, a whole-of-society approach is necessary to end HIV. That’s what has made PEPFAR so innovative and so successful; it brings many parties with a common goal together. Everyone works together to understand exactly what the issues are and to ensure that the people at the center of those issues have a say in how they are resolved.
The GAPP unites people in a similar way, bringing together all of the actors—from advocates to practitioners to the private sector and beyond—to speak about the issues and coordinate our actions. I think that’s extremely powerful.