The US President’s Emergency Plan for AIDS Relief has been a cornerstone of global HIV/AIDS prevention, care and treatment for over two decades. Pepfar has enjoyed broad bipartisan support in the US, but its future is now uncertain. Public health scholars Eric A. Friedman, Sarah A. Wetter and Lawrence O. Gostin explain Pepfar’s history and impacts, as well as what may lie ahead.
The early years
Many people today have forgotten the sheer devastation that the AIDS pandemic wrought on the African continent, first spreading widely in east Africa in the 1980s. By the end of the 20th century, life expectancy in the region had decreased from 64 to 47 years.
Millions of children were infected and many grew up as orphans, with HIV taking the life of one or both of their parents. Children, especially girls, were taken out of school to nurse sick relatives or because school fees were unaffordable.
Underfunded health systems were near collapse, as were the economies of many African countries.
Infection rates in several countries on the continent topped 30% of their adult populations.
These devastating figures persisted despite the discovery of highly effective antiretroviral therapies in the 1990s. These drugs rapidly became widely available in rich countries, beginning in 1996, leading to an 84% decline in death rates over four years.
But cost kept the drugs out of reach for African countries.
Only about 100,000 of the 20 million people infected with HIV in Africa were accessing drug treatment in 2003.
