PEPFAR: Oh what good you have done!

In 1982, the first case of HIV was reported in South Africa. Thereafter the unerring march of AIDS and death ravaged our communities, filled our hospital beds and cemeteries and rendered families bereft of young breadwinners, parents and children.

Anti-HIV treatment, known as antiretroviral therapy was the miraculous epidemic game changer – but it was only available to the richer nations that could afford the drugs. In 2002, the vision of Africa that came sharply into view was one where millions of our young people were dying and where social, economic and political destabilisation was evident.

The Presidents Emergency Plan for AIDS Relief (or PEPFAR), implemented in 2003, was a brilliant, generous and greatly valued intervention that changed the potential course of history forever. Under PEPFAR, we have seen a miraculous change to the narrative surrounding the AIDS response in Africa. This has included increasing access to HIV treatment, reductions in new infections through biomedical and behavioural prevention interventions, and an overall strengthening of health systems.

PEPFAR works closely with the South African Government and the Global Fund to Fight AIDS, Malaria and Tuberculosis. In 2016 alone, this collaboration provided ARVs for more than 3.4 million people, HIV counselling and testing for 10.4 million people, care and support for 407 056 orphans and adolescents affected by HIV/IADS, and medication for 220 626 pregnant HIV positive women to prevent mother to child transmission. The Global Plan for prevention of mother to child transmission has moved us very close to the complete eradication of transmission of HIV from women to their offspring.

We are now poised to move into the second chapter of the narrative where we can hope to see the numbers of new infections recede; communities again becoming strong and resilient, and African countries taking ownership and setting new benchmarks of health and wellbeing being set on the continent. We have new, strong HIV prevention tools and we know now more than ever how to engineer effective and exciting interventions, which include a possible cure and a preventative vaccine.

But it remains a tenuous fragile time….we can turn the page and move forward to a good ending or disengage too soon, lose all the gains we have made to date and slide back to a situation far worse that we have ever imagined.

PEPFAR was started by US President George Bush, expanded by US President Barack Obama and currently funds anti-AIDS activities in more than 60 countries. These funds come from the American people, and we are ever grateful for the huge contribution and difference they have made. Unfortunately, the change of administration in 2016 has resulted in a proposed reduction in the PEPFAR funding to a 5th of its current value, and a reduction of the countries it is active in, to a mere 11. This sits alongside a reduction in funding to the Global Fund to Fight AIDS, Tuberculosis and Malaria. The impact of this on the HIV/AIDS response in developing countries will be enormous.

The HIV epidemic is far from over. Sub-Saharan Africa retains the highest HIV burden in the world today. AIDS continues to stalk our young people and rob our communities. The time is now, the challenge remains, and the reward is bigger than before! We continue to need global effort and investment in getting this job done!