PEPFAR’S 20: Reflecting on the United States’ Mission to Save Lives Globally

U.S. Embassy Chargé d'Affaires Amanda S. Jacobsen meets with former Botswana President Festus Gontebanye Mogae at the 2022 American Independence Day celebration in Gaborone. President Mogae was instrumental in the launch of the PEPFAR program in Botswana.

By the U.S. Embassy Chargé d’Affaires Amanda S. Jacobsen

This month we mark twenty years of PEPFAR, the U.S. President’s Emergency Plan for AIDS Relief, and we commit ourselves to ending HIV/AIDS as a public health threat by 2030.

Former U.S. President George W. Bush launched PEPFAR in 2003.  Thanks to the compassion and generosity of the American people, PEPFAR has helped to save more than 25 million lives across the globe.

Globally, since the establishment of PEPFAR, new HIV infections have been reduced by 42 percent since their peak in 2004, and AIDS-related deaths have declined by 64 percent since their peak that same year.  These successes are largely due to PEPFAR and U.S. contributions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

In 2003, when PEPFAR launched, an HIV diagnosis was a death sentence in Botswana, as it was in much of the world; entire families and communities were falling ill.  Since PEPFAR’s inception, the narrative of death and despair has overwhelmingly turned to that of vibrant lives and hope.

For 20 years, PEPFAR has supported the Government of Botswana through U.S. government agencies, including the Centers for Disease Control and Prevention (CDC), the Department of Defense (DOD), the Health Resources and Services Administration (HRSA), the Peace Corps, and the U.S. Agency for International Development (USAID).  Through this robust U.S.-Botswana partnership and with the hard work of our implementing partner organizations across the country, we have not only saved and improved hundreds of thousands of lives, but we have also transformed Botswana’s HIV/AIDS response.

PEPFAR leverages the best of U.S. capacity and ingenuity from the scientific community, academic institutions, private sector, and faith and community-based organizations.  Working together with implementing partners in more than 50 countries, PEPFAR has accelerated progress toward controlling the HIV/AIDS pandemic – community by community.

Partnerships are a major component of PEPFAR.  The U.S. Global AIDS Coordinator and Special Representative for Health Diplomacy, Ambassador Dr. John Nkengasong, who oversees PEPFAR says, “Nothing can be achieved without partnerships – it is one of the key drivers of the remarkable impact the PEPFAR program has had over the past 20 years, and partnerships are critical to the program’s future success.”

The U.S. government is dedicated to supporting Botswana’s ownership and vision towards achieving and sustaining near-universal prevention and treatment coverage of HIV/AIDS, effectively using local capacity, improving coordination, finding efficiencies, and supporting Botswana’s health priorities.

Investments in PEPFAR are crucial to overall health systems and global health security.  Worldwide, PEPFAR has supported programs at more than 70,000 facilities and community health clinics, including 3,000 laboratories; trained over 340,000 healthcare workers; enhanced disease surveillance, supply chain, health and laboratory information systems; built community capabilities; and applied analyses of data for decision making.

Over the past two decades, PEPFAR has played a critical role in building the health architecture of partner nations, including Botswana.  PEPFAR has trained medical personnel, created prevention programs, provided broad-use diagnostic equipment and personal protective equipment (PPE), and established systems to trace infections.  These efforts have helped many countries to better respond to other global health crises such as COVID-19, Mpox, and Ebola.

Understanding that people living with HIV are at higher risk of other diseases, we will continue to invest in sustainable health systems that promote health equity.

PEPFAR supports the efforts of Botswana’s Ministry of Health (MoH) in its elimination of mother-to-child HIV transmission (MTCT) national strategies.  In December 2021, the World Health Organization (WHO) awarded Botswana “Silver Tier” status for lowering the MTCT rate to less than five percent and providing prenatal care and antiretroviral therapy (ART) to more than 90 percent of pregnant women living with HIV.  This is a remarkable achievement for a country with one of the highest HIV prevalence rates worldwide.  This success demonstrates that ending the HIV epidemic is possible.  PEPFAR is now supporting the MoH to achieve WHO “Gold Tier” certification, which requires maintaining MTCT at less than five percent, increasing the provision of prenatal care and anti-retroviral treatment to more than 95 percent of pregnant women, and includes eliminating mother-to-child transmission of hepatitis B and syphilis (dubbed “triple elimination.”)

In 2022 the Government of Botswana and PEPFAR celebrated the results of the Botswana AIDS Impact Survey V (BAIS V).  This was the first population-based survey in which Botswana exceeded the UNAIDS 95-95-95 epidemic control targets.  The survey revealed that 95 percent of all people living with HIV in Botswana knew their HIV status; 98 percent of all people diagnosed with HIV were receiving sustained antiretroviral therapy (ART); and 98 percent of all people receiving ART were virally suppressed.

On this auspicious 20th anniversary, we are focused on what PEPFAR can do in service to the many people who remain affected by HIV/AIDS.  We are recommitting ourselves to working with partner governments, private and public organizations, the faith-based community, multilateral organizations, and others to end HIV/AIDS as a public health threat by 2030.

The end of HIV/AIDS as a public health threat by 2030 is an ambitious but achievable goal.  On World AIDS Day 2022, President Biden declared, “We finally have the scientific understanding, treatments, and tools to build an AIDS-free future where everyone – no matter who they are, where they come from, or whom they love – can get the care and respect they deserve.”