Congress must reauthorize AIDS relief: We still have work to do

The President’s Emergency Plan for AIDS Relief (PEPFAR) has saved more than 25 million lives over the past two decades through the generosity of the American people.

Through HIV prevention, testing and treatment, it has provided opportunity and hope to millions of people who otherwise would have faced a grim future. At the same time, it has advanced U.S. national security interests, engendered goodwill toward America, and helped thwart extremism. Few programs have achieved a better return on investment. Indeed, PEPFAR stands as one of the most successful foreign assistance programs ever.

Congress needs to vote this year to reauthorize this lifesaving program, as it has done three times before with strong bipartisan and bicameral support. I urged lawmakers to act with principle and conviction to reauthorize PEPFAR for five more years in a letter to the Senate Foreign Relations Committee before a hearing on PEPFAR Wednesday. Reauthorization without changes will ensure Republican and Democratic backing of the program — which has previously been reauthorized over 11 sessions of Congress and four administrations.

This issue is very dear to the hearts of former President George W. Bush and former first lady Laura Bush. President Bush launched PEPFAR 20 years ago out of a moral imperative: As he often says, we are all God’s children and all deserve a shot at life. And to whom much is given much is required. 

Before PEPFAR, an entire generation in sub-Saharan Africa risked being wiped out. AIDS was killing millions, destabilizing societies, impoverishing economies and creating a climate of desperation that nefarious actors could exploit. Helping save lives in Africa stands in stark and more favorable contrast to the exploitative approach that Russia and China take toward the continent, demonstrating no apparent concern whatever for human life.

The United States isn’t alone in working to combat this disease. The Global Fund to Fight AIDS, Tuberculosis, and Malaria this past year received a record $15.7 billion in pledges for a three-year period from over 70 nations and nongovernmental entities.

PEPFAR works so well because it focuses on results, transparency and critical accountability. Every dollar spent is carefully tracked to prevent waste, corruption and fraud.

Strong national leadership has also been critical to PEPFAR’s success in ensuring essential policies in countries where the program operates advance the program’s impact. Many partner governments are increasingly funding key aspects of the program and taking on greater responsibility for its implementation.

Civil society, community groups and local faith-based organizations have played crucial roles as well, helping PEPFAR reach people with critical prevention and treatment services. These local organizations receive most of PEPFAR’s funding to implement programs.

I was lucky enough to see PEPFAR’s work in action when I met Tatu Msangi and Faith Mang’ehe, a mother and daughter from Tanzania who credit PEPFAR with saving both their lives, at a celebration of PEPFAR’s 20th anniversary in February. Tatu discovered she was HIV positive while pregnant with Faith. Thanks to treatment made possible by PEPFAR, Faith was born without the disease, is now 17 and thriving. It’s virtually undetectable in Tatu now, too.

While saving lives from HIV/AIDS is, of course, PEPFAR’s biggest achievement, the program has reaped other benefits.

Economies of countries that received PEPFAR resources grew 2.1 percentage points faster between 2004 and 2008 than they would have without the program, according to the Kaiser Family Foundation. Investments made under PEPFAR in hospitals, clinics, labs and health workers allow countries to respond quickly when other health crises strike, like Ebola and COVID-19.

PEPFAR is also integrating new services to care for people living with HIV, such as “Go Further,” a public-private partnership created five years ago with UNAIDS, Merck, Roche, and the George W. Bush Institute to end AIDS and cervical cancer. It targets women in Africa living with HIV, who are six times more likely to develop cervical cancer. Go Further has conducted more than 5.7 million cervical cancer screenings and treated more than 217,000 precancerous lesions.

Despite PEPFAR’s successes, more than 1 million people are still newly infected with HIV each year, according to UNAIDS. Many of the most vulnerable are young people Faith’s age who may have been saved from infection as infants, but now face this scourge again as young adults.

American leadership and the participation of our friends and allies in governments, civil society and the private sector remain critical to get the AIDS pandemic under control.

Americans can take great pride in the lives we’ve saved and the societies we’ve improved. But we can’t quit now. We must finish the job.

David J. Kramer is executive director of the George W. Bush Institute.