Partnerships Create Hope

For more than 25 years, the global community has witnessed the devastating impact of HIV/AIDS. Until recently, many wondered whether prevention, treatment and care could ever make a measurable impact, particularly in resource-limited settings where HIV was a death sentence.

Just 5 years ago, only 50,000 people living with HIV in all of sub-Saharan Africa were receiving antiretroviral treatment. Recognizing that HIV/AIDS was and is a global health emergency requiring emergency action, the U.S. Government, including a bipartisan, bicameral Congress reflected the compassion and generosity of the American people.

Their creation, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), holds a unique place in the history of public health for its size and scope:

In size, with an original commitment of $15 billion over 5 years, and a final funding level of $18.8 billion, it is the largest international health initiative in history dedicated to a single disease and also the largest development initiative in the world. The first phase of PEPFAR went beyond a commitment to allocating resources to a commitment to achieving results, with ambitious goals to support prevention of 7 million new infections, treatment of 2 million and care for 10 million, including orphans and vulnerable children.

In scope, it is the first large-scale effort to tackle a chronic disease in the developing world. It moves beyond isolated efforts and pendulum swings that led programs to focus on prevention or treatment or care for HIV/AIDS, to sound public health principles — integrated prevention, treatment and care.

The success of PEPFAR is firmly rooted in a commitment to results. Through partnerships between the American people and the people of the countries in which we are privileged to serve — governments, non-governmental organizations including faith-based organizations and community-based organizations, and the private sector — we are building sustainable systems and empowering individuals, communities, and nations to battle HIV/AIDS.

Together, we have acted quickly. We have already obligated 92 percent of the funds initially appropriated to PEPFAR and have expended or outlayed 68 percent of those resources.

Partnerships for Prevention

The world cannot defeat this pandemic through treatment and care alone. The UNAIDS 2008 Report on the Global AIDS Epidemic estimates that there were approximately 2.7 million new HIV infections in 2007.

This indicates that new infections still far outpace the world’s ability to add people to treatment. The best approach to the challenges posed by HIV/AIDS is to prevent infection in the first place.

PEPFAR supports the most comprehensive, evidence-based prevention program in the world, targeting interventions based on the epidemiology of HIV infection in each country.

These include reducing sexual transmission with the ABC Strategy (Abstain, Be Faithful, correct and consistent use of Condoms), the prevention of mother-to-child transmission, the transmission of HIV through unsafe blood and medial injections, and male circumcision.

PEPFAR also integrates new prevention methods and technologies as evidence is accumulated and normative guidance provided. It is important for prevention activities to enter the 21st century and keep pace with evidence-based techniques and modalities that have been developed to change human behavior, especially those developed in the private sector for commercial marketing.

Partnerships for Treatment

AIDS is still among the most deadly infectious diseases in the world. In sub-Saharan Africa, the epicenter of the pandemic, it is the leading cause of death. More than 22 million of those infected — more than two thirds of all people living with HIV/AIDS — live in the region, and approximately 1.7 million people die of AIDS there each year, more than three-quarters of the global total.

However, there is new reason for hope. On a global basis, UNAIDS also estimates that the number of people dying of AIDS-related causes has declined in recent years, from 2.2 million in 2005 to 2.1 million in 2007. This is the first time such a decline has occurred, and the change is due largely to the increased availability of antiretroviral treatment — though improved prevention and care programs have likely contributed as well.

Lives prolonged through treatment benefit not only those on treatment. The ultimate measure of treatment is the daily impact on individual lives, and therefore on their families, communities and nations.

Partnerships for Care

As the pendulum on HIV/AIDS interventions swings between prevention and treatment, it is often care that is lost. Yet care is a critical element of a truly comprehensive approach to fighting HIV/AIDS.

As defined within PEPFAR, there are three key dimensions to care: care for orphans and vulnerable children; care and support (other than antiretroviral treatment) for people infected with or affected by HIV/AIDS; and HIV counseling and testing (which has been counted as Care during the first phase of PEPFAR, but will be counted as part of Prevention for future years). Despite significant progress by PEPFAR in all three areas, much more needs to be done.

Recognizing the central importance of preserving families, PEPFAR focuses on strengthening the capacity of families to protect and care for orphans and vulnerable children by prolonging the lives of parents and caregivers.

PEPFAR also provides “care and support,” which refers to the wide range of services other than antiretroviral treatment offered to people living with HIV/AIDS and other affected persons, such as family members. Care and support comprises five categories of services: clinical (including prevention and treatment of opportunistic infections and AIDS-related malignancies, and pain and symptom management), psychological, social, spiritual, and preventive services.

In addition, knowing one’s status provides a gateway for critical prevention, treatment, and care. Millions of people must be tested in order for PEPFAR to meet its ambitious prevention, treatment and care goals. PEPFAR programs have worked to ensure that counseling and testing is targeted to those at increased risk of HIV infection such as tuberculosis patients and women seeking services to prevent the transmission of HIV from mother-to-child.

Working with International Partners

The United States is not the only international partner of host nations. Other key international partners include: the Global Fund; the World Bank; United Nations agencies, led by UNAIDS; other national governments; and increasingly the businesses and foundations of the private sector. All of these partners have vital contributions to make to the work of saving lives around the world.

Through PEPFAR, the U.S. Government is the first and largest contributor to the Global Fund to Fight AIDS, Tuberculosis, and Malaria, a multilateral organization that provides an important vehicle for other nations to increase their commitments on the three diseases. To date, the U.S. Government has contributed more than $3.3 billion to the Global Fund. And as of September 2008, PEPFAR and the Global Fund reported supporting antiretroviral treatment for a collective total of 2,952,600 persons.

The United States was a driving force behind the creation of UNAIDS’ “Three Ones” principles for support of national HIV/AIDS leadership and continues to support UNAIDS’ work in a variety of ways.

Promoting Sustainability and Accountability

PEPFAR supports enduring contributions that build health systems as part of a broader development approach. PEPFAR is working to ensure a sustainable response by building the capacity of public and private institutions in host nations to respond to HIV/AIDS.

With support from PEPFAR, host countries are developing and expanding a culture of accountability

While HIV/AIDS is unmistakably the focus of PEPFAR, the initiative’s support for technical and organizational capacity-building for local organizations has important spillover effects that support nations’ broader efforts for sustainable development.

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