Our global plan to fight HIV has been a strategic weapon against COVID

The COVID-19 pandemic has touched every corner of our world, including our families and communities. Many of us have lost loved ones and had our lives upended in a myriad of ways.  Amidst this tragedy, we have witnessed countless acts of compassion, generosity, and courage, reminding us all of our common humanity. 

As the global community remains focused on controlling the COVID-19 pandemic, we must not forget the persistent challenge of the global HIV epidemic, now entering its fifth decade. Last year, 1.5 million people were infected with HIV and nearly 700,000 people died of AIDS-related illnesses worldwide. These figures have declined markedly from their historic peaks — largely thanks to the U.S. government’s strong bipartisan global AIDS leadership and investment — but HIV continues to take a devastating toll on millions of people worldwide. 

Over the past 18 months, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has continued to save and improve lives through swift and decisive action driven by data, agility, and innovation. Since early March 2020, we have worked with countries, communities and partners on two primary goals: Protecting and advancing global HIV gains, including for the most vulnerable and marginalized, and supporting the global COVID-19 response by leveraging the robust public health and clinical platforms in place after nearly two decades of PEPFAR investments. 

When COVID-19 hit, PEPFAR responded immediately to adapt service delivery, accelerate program innovation and drive policy change to better serve our clients. This included dramatically expanding decentralized distribution and multi-month dispensing of life-saving antiretroviral medications to keep clients in care and reduce their exposure to COVID-19. Through these actions, PEPFAR has not only ensured continuity of lifesaving medication for people living with HIV, but also delivered HIV treatment to 1 million more people in the last six months, now reaching over 18.4 million people globally.

PEPFAR also took early action on COVID-19 infection prevention and control measures to protect our clients and the health care workers who serve them. While these necessary steps initially slowed progress in some HIV prevention programs, they have since rebounded strongly. In the past six months, PEPFAR has supported 2 million more young men with voluntary medical male circumcision for HIV prevention; doubled the number of adolescent girls and young women starting pre-exposure prophylaxis, or PrEP; and substantially expanded HIV self-testing. We have also supported 45 million HIV tests in this fiscal year alone.   

One of PEPFAR’s most impactful living legacies is the robust and enduring public health and clinical platforms that we have helped build in partner countries. Through over $1 billion annually in health systems strengthening investments across 55 countries, PEPFAR currently supports programs at more than 70,000 facility and community health clinics, including 3,000 laboratories; over 290,000 health care workers; expansive supply chains for health care commodities; and strong systems for data collection and use.  These capacities have directly impacted the global capacity to detect and fight COVID-19. 

PEPFAR-supported laboratories have been used by countries to complete tens of millions of COVID-19 tests. Thousands of PEPFAR-trained community health care workers have gotten COVID-19 testing to those who are most in need, all while supporting antiretroviral adherence. Countries have utilized surveillance capabilities — built partly with PEPFAR investments for HIV detection — to identify COVID-19 hot spots and appropriately deploy health care resources. PEPFAR-supported health care workers are also supporting COVID-19 vaccine readiness and administration.  

Health management information systems, created with PEPFAR assistance for HIV programs, have aided in collecting and using data on COVID-19 cases, deaths and vaccinations. Health care supply chains forged with PEPFAR financial and technical resources have delivered COVID-19 test kits, personal protective equipment, laboratory reagents, and other essential commodities. Few of these capabilities would have been available at scale or with the needed sophistication without PEPFAR’s longstanding investment and bipartisan congressional support.   

As we continue to fight COVID-19 and HIV, we still have much to learn and do. The COVID-19 pandemic has accelerated innovations in HIV service delivery, making it more client-centered, agile, and resource-efficient. PEPFAR-supported public health and clinical platforms in countries have proven responsive and resilient — advancing HIV progress despite challenging conditions, and being leveraged to deliver broader, more equitable health care access. Together, we have gained critical insights for effective pandemic preparedness and response.  

The age of COVID-19 and HIV is still upon us, and PEPFAR remains poised to continue meeting these and other challenges head on — now and into the future. 

Dr. Angeli Achrekar serves as the acting U.S. Global AIDS Coordinator, since January 2021. Achrekar works with leaders across the State Department’s Office of the Global AIDS Coordinator and among the seven federal agencies that implement the U.S. President’s Emergency Plan for AIDS Relief to ensure effective and efficient management, coordination and program implementation.