The President’s Emergency Plan for AIDS Relief — PEPFAR — credited with saving more than 26 million lives around the world, is facing an uncertain future as Congress has failed to reauthorize it this year.
PEPFAR, established in 2003 by President George W. Bush, is widely regarded as one of the world’s most successful public health programs. PEPFAR provides antiretroviral treatment to those affected with HIV/AIDS. It also offers prevention programs to 50 countries around the world. Thus far, the US has invested about $100 billion in PEPFAR.
The program’s authorization expired on March 25; to date, Congress has not reauthorized the program. Nonetheless, $7.1 billion has been allocated for FY 2024, which ends on Sept. 30.
“Antiretroviral therapy — ART — is simple, it’s powerful, it’s transformative,” said Dr. Jirair Ratevosian, Associate Research Scientist at Yale. The once-daily pill suppresses the virus and stops HIV transmission, he explained at an American Community Media news briefing May 30.
“People on treatment not only live longer, they actually don’t pass HIV. So treatment in some ways is actually prevention,” said Ratevosian. “But here’s the catch: treatment only works if it’s uninterrupted.” When treatment is stopped, the person is no longer biologically suppressed: they can then transmit their infection, putting those around them at risk, he explained.
100,000 Deaths
Earlier this year, the Trump Administration placed a 90-day pause on all foreign aid, including funding for PEPFAR. The impact of that pause was devastating. “There were significant disruptions in people’s access to treatment, including several clinic closures in many parts of the world. The waiver also excluded support for HIV prevention programs that are the very backbone of epidemic control,” said Ratevosian.
“Our team did an assessment of what this 90-day pause on foreign assistance for HIV could look like. We have published a study to show that up to 100,000 preventative deaths would occur in just one year due to this 90-day pause, and that was a conservative estimate.”
”Subsequent modeling and studies have confirmed that these disruptions are likely to remove thousands of people from treatment regimens that exist around the world. Tens of thousands of new infections would be caused because people were undetected and untreated. This is not hypothetical. It’s actually an unfolding reality now,” said Ratevosian.
11 Million New HIV Infections
“Ending PEPFAR could result in up to 11 million additional new HIV infections and 3 million additional deaths by 2030. And that’s just a subset of PEPFAR countries that were studied as part of this analysis. So we’re urging Congress to act quickly to reauthorize PEPFAR, because delays and policy delays can lead to more lives being disrupted and more lives being lost,” he said.
The researcher noted that the push for reauthorization has re-energized the HIV/AIDS movement. “This is happening in a way that we haven’t seen since the 1980s. HIV activists are disrupting Congressional hearings, protesting, and marching to the State Department. It makes me very optimistic,” said Ratevosian.
Concurrently, the National Institutes of Health has terminated at least 145 grants worth $450 million related to HIV and AIDS research, including vaccine research. In the 42 years since the illness was first identified, no vaccine has been brought to market, though several significant trials are underway.
