March 20, 2025
The US President’s Emergency Plan for AIDS Relief (PEPFAR) is one of the greatest investments in global health and US diplomacy. With over 20 years of partnership and huge impact, PEPFAR is critical to ending HIV as a public health threat for everybody, everywhere. Champions of global health and evidence-based HIV prevention made clear the potential to end the epidemic or to lose decades of progress in fighting HIV at a March 5th US Congressional briefing, hosted by Congresswoman Robin Kelly, the Congressional Caucus on Black Women and Girls, AVAC and the Global AIDS Policy Partnership (GAPP).
PEPFAR and its lifesaving services have been threatened by the new US administration’s executive order freezing all foreign aid funding. While some PEPFAR programs received waivers to restart some HIV treatment and prevention of mother-to-child transmission (PMTCT) services, many of its activities continue to be suspended indefinitely, including programs for girls, young women, orphans, and vulnerable children. PEPFAR’s authorization expires on March 25.
“The hardest hit are key populations, those already on the margins of society,” said AVAC’s John Meade Jr., Senior Manager for Policy who co-moderated the briefing. “Clinics are shutting down, and communities are losing access to prevention and treatment. Congress must act immediately to restore funds to this extraordinary program. This is not a partisan issue. PEPFAR has enjoyed bipartisan support because it works, because it saves lives. It strengthens economies and reinforces America’s role as a leader in global health.”
Chris Collins, President and CEO of the Friends of the Global Fight Against AIDS, Tuberculosis and Malaria and AVAC co-founder, said that since 2003 when PEPFAR began, it has delivered an unprecedented success in mounting a response against HIV/AIDS, saving 26 million lives and building systems and infrastructure that effectively deliver treatment and prevention.
“People need to understand, we are on a trajectory to end the epidemic with PEPFAR. What it would mean for the United States to continue to lead this global effort would be one of the greatest accomplishments of the century. And it would be an American accomplishment with our partners around the world. There’s a huge prize out there waiting.”
Participants all referenced the UNAIDS goal of ending AIDS as a public health threat by 2030. Angeli Achrekar, Deputy Executive Director of the UNAIDS, described the grave risks of missing this moment: “The end is almost in sight. Yet, if we do not get to the end, we risk serious resurgence. Those gains, that have been made with so much investment and engagement by governments and American taxpayers, will be reversed. We risk backsliding in all this strategic engagement. It’s a reality we all have to face.”
Achrekar said PEPFAR’s fight against HIV/AIDS has led to extensive public and private investment, and among many US businesses, who have strengthened lab and surveillance technology, supply chains, data science, monitoring and evaluation, and healthcare systems at large.
“The result is that countries are not just able to respond to HIV but also to COVID, mpox, Ebola, H1N1 and other threats. That is so important, to stop diseases where they are and prevent them coming to the US,” said Achrekar.
Linda-Gail Bekker, CEO of the Desmond Tutu Health Foundation in South Africa and an AVAC board member, shared the results of a recent modelling study, Potential Clinical and Economic Impacts of Cutbacks in the President’s Emergency Plan for AIDS Relief Program in South Africa: A Modeling Analysis, which found that eliminating PEPFAR would lead to 600,000 additional HIV-related deaths and 565,000 additional HIV infections over 10 years, and increased healthcare expenditures across the population by approximately $1.7 billion. And Bekker decried the additional impact on HIV R&D from US policy under the new administration.
“We are damaging our ability to do ethical clinical research, which I fear because although we have made strides, we have yet to discover an HIV vaccine that is effective, we still have a real quest for a cure, and it takes great effort to stay one step ahead of this virus with treatment and prevention.”
Jirair Ratevosian of the Duke Global Health Institute detailed a 2 to 5 year transition plan for PEPFAR countries to achieve 50% co-financing of their programs, repurpose funding to places where the epidemic is intensifying, and cost-savings through scaled-up prevention of long-acting PrEP for 5 million new users by 2030. Read the recommendations in Reform and Renewal: Five Recommendations for PEPFAR. The prevention target builds on a landmark agreement, announced in December 2024, between PEPFAR, Global Fund, the Children’s Investment Fund Foundation and the Gates Foundation, to provide affordable access to injectable lenacapavir, aiming to reach 2 million people over three years in PEPFAR and Global Fund–supported countries.
“Let’s not forget the amazing opportunity in front of us right now, which is scale-up of long-acting PrEP,” said Ratevosian. “There are two long-acting prevention products right now. If we can get those out to the people most at risk, we can drive down HIV incidence dramatically, in combination with getting treatment to everybody who needs it. That’s the real sustainability in HIV, where countries can take on their own response if we can get these epidemics under control—and that’s do-able if we go to scale with the technology we have.”
In the midst of chaos and confusion, Congress and the new administration need to recognize that ending an epidemic is both the right thing to do and completely possible at this moment in history. Embracing the policies and funding to make it happen makes America and the world stronger, safer, and more prosperous.