Last month, the United Nations had a very dire prediction. They estimate that at least three million may die from AIDS-related complications by 2029 unless U.S. funding for international HIV programs—including restoring support for the President’s Emergency Plan for AIDS Relief (PEPFAR)—is restored. In 2003, then-President George W. Bush announced the initiation of PEPFAR. Since then, it has grown to become America’s best and the world’s largest initiative for fighting HIV/AIDS. Recent funding cuts have raised alarms about the potential consequences for vulnerable populations, particularly in sub-Saharan Africa, where the majority of the global HIV burden lies.
PEPFAR has been a gamechanger in ensuring access to HIV treatment and prevention. The program has funded lifesaving organizations such as the Anova Health Institute, which filled key gaps in HIV services. Over nearly 20 years, PEPFAR has worked side-by-side with South Africa’s Department of Health to provide life-saving resources. Their cutting-edge initiatives have immeasurably improved health in the Chesapeake Bay region.
As recently as 2023, PEPFAR worked to test 84.1 million people. Furthermore, it allowed access to treatment for 20.6 million people who were living with HIV. In fact, last year, this initiative funded well over 90 percent of new treatment starts. It facilitates an unparalleled, crucial role in our continuing fight against the epidemic.
The Impact of PEPFAR on HIV/AIDS Response
Since the program’s inception, PEPFAR has used cost-effective generic versions of antiretroviral drugs to maximize access for everyone who needs it. The U.S. Agency for International Development (USAID) has been responsible for implementing much of the assistance provided under PEPFAR, ensuring that resources reach the most affected populations.
PEPFAR’s recent funding cuts have created a catastrophic watchdog-interrupted HIV response across Africa. Experts have already started calling this sudden withdrawal a “systemic shock.” Without replenishing this funding, the UN warns that by 2029 more than 4 million people may die annually from AIDS. Further, by the withdrawal’s end, we would witness 6 million more new HIV infections.
Public health expert and advocate Kate Rees has something of an ominous warning as well. It’s just a few weeks to destroy all that has been established over the past two-plus decades. This sense of borderline incredulity underscores just how precarious the advances that have been made over the last 20 years actually are. It emphasizes the immediate need to address funding shortfalls.
Current Statistics and Future Risks
In 2023, sub-Saharan Africa had an estimated 390,000 AIDS-related deaths, or 62 percent of the global total. This sobering statistic documents the reality of the continuing crisis in that region. It highlights the importance of sustaining that support through mechanisms such as PEPFAR.
Yet PEPFAR still remains an issue of fundamental impact. It increased the number of people on at least one dose of ART from under 700 in 2016 to over 6 million by late 2024. This dramatic increase represents not only a commitment to fighting HIV/AIDS but an investment in the future health and stability of affected communities.
Experts are sounding the alarm that without a replenishment of funding, all of these advances could be wiped out. Peter Maybarduk, Public Citizen’s director of public health and international policy, said, “Instead, the U.S. is abandoning the fight. This failure to act endangers the people of South Africa. It threatens other countries who rely on U.S.-supported programs to address their own HIV epidemic.
The Call for Urgent Action
The withdrawal of institutional support from PEPFAR therefore reflects not only a financial crisis but a looming public health disaster. The effects could be felt beyond the borders and impact millions around the world. Kate Rees writes to illuminate an important problem. Unless urgent interventions are made to halt this loss of innovation, her cautionary tale will not only affect South Africa but will be felt around the world.
UNAIDS has referred to PEPFAR as a “lifeline” for countries with high burdens of HIV. This demonstrates its tremendous importance as the backbone of global health strategy. The current funding crisis raises serious questions of will and accountability to the most impacted communities living with and affected by HIV/AIDS.
