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At the end of January, the Trump Administration ordered a stop-work for all global health funding, which included the US President’s Emergency Plan for AIDS Relief (PEPFAR) program.
This long-standing public health initiative, started by President George W. Bush, has played a critical role in addressing the HIV/AIDS epidemic, particularly in sub-Saharan Africa.
In 2003—the year PEPFAR was announced—sub-Saharan Africa was in the throes of the HIV/AIDS epidemic, with between 25–28.2 million adults and children living with the virus and 2.2–2.4 million AIDS-related deaths reported that same year.¹
With PEPFAR stepping in to offer HIV prevention, treatment, and care, the impact has been substantial.
In sub-Saharan Africa, the lifetime risk of contracting HIV has decreased by 60% since its peak in 1995. Additionally, the number of people without suppressed HIV levels dropped from 19.7 million in 2003 to 11.3 million in 2021.²
The program is estimated to have saved more than 26 million lives and ensured that 7.8 million babies were born HIV-free. It currently supports over 20 million people with HIV prevention and treatment services, primarily in sub-Saharan Africa.³
However, a new analysis published today in The Lancet, highlights the potential consequences of permanently halting PEPFAR funding. The study estimates that, without stable, ongoing support, up to 1 million children could become infected with HIV, nearly half a million could die from AIDS by 2030, and 2.8 million children could be orphaned in the region.³
“The future of PEPFAR programs hang in the balance. Losing stable, long-term support for PEPFAR programs sets global progress to end HIV/AIDS back to the dark ages of the epidemic, especially for children and adolescents,” co-lead author Lucie Cluver, DPhil, professor, University of Oxford (UK), said in a statement. “A sudden withdrawal of PEPFAR programs, especially in the absence of a long term strategy to replace them, could lead to a resurgence of HIV infections and preventable deaths, and a dramatic rise in the number of children orphaned by AIDS in the coming years—a setback that could erode 2 decades of progress.” 4
What You Need to Know
Since its launch in 2003, PEPFAR has significantly reduced HIV infections and AIDS-related deaths in sub-Saharan Africa, saving over 26 million lives and preventing 7.8 million children from being born with HIV.
Without continued support, up to 1 million children could become infected with HIV, nearly half a million could die from AIDS, and millions more could be orphaned by 2030—undermining hard-won progress in the fight against HIV/AIDS.
Sustaining PEPFAR not only protects global health but also strengthens U.S. diplomacy, national security, and international influence—especially as other global powers seek to expand their reach in Africa.
The authors conducted an original modeled analysis using existing data to predict the risks children in sub-Saharan Africa would face without PEPFAR programs. Their estimates suggest that, by 2030, there could be 1 million new pediatric HIV cases, 460,000 additional AIDS-related child deaths, and 2.8 million more children orphaned.³
A Call to Action
In the face of ongoing funding disruptions to US foreign assistance programs, the study’s investigators are calling for urgent action to continue life-saving interventions for children and families affected by HIV/AIDS in sub-Saharan Africa.
The authors also outline ways to make PEPFAR programs more sustainable. These include strengthening partnerships with both international and local stakeholders, closing funding gaps, increasing country- and community-led initiatives, and enhancing domestic healthcare systems. PEPFAR-supported countries in Africa have already demonstrated strong commitment to HIV response ownership, with co-financing for health systems increasing from $13.1 billion in 2004 to $40.7 billion in 2021.
“Renewing PEPFAR investments safeguards the health and well-being of millions of people and reinforces the USA’s position as a global leader in foreign assistance and health diplomacy,” co-lead author Gibstar Makangila, Executive Director of Circle of Hope (Zambia) said in a statement. “Programs like PEPFAR have successfully elevated public opinion of the USA and enabled bilateral cooperation not only with countries receiving PEPFAR support, but also globally, which in turn contributes to protecting national security, strengthening trade, and advancing strategic diplomacy. Ending PEPFAR would create a void likely filled by other countries, with reports indicating China and Iran are poised to assume global health leadership roles, enabling them to increase their influence in the region.” 4
