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PEPFAR report serves as a beacon and a warning

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Paul Auwaerter, MD, MBA, President IDSA

Melanie Thompson, MD, Chair, HIVMA Board of Directors


The 2018 Annual Report to Congress released by the United States President’s Emergency Plan for AIDS Relief tells a story of remarkable progress and opportunity. Just a decade and a half after its inception, PEPFAR has provided life-saving antiretroviral treatment to 13.3 million people living with HIV, given access to medical circumcision that reduces risks of HIV infection to 15.2 million men and boys, and services that have prevented infection in 2.2 million babies born to mothers living with HIV. The program has also supported preventive treatment against tuberculosis in 17 countries. As the report notes, PEPFAR has opened the opportunity to end the devastation caused by HIV by the end of the next decade.

The members of the Infectious Diseases Society of America and the HIV Medicine Association urge our leaders in Congress and the White House to ensure that PEPFAR reaches its goals, by providing the resources necessary to respond to the significant unmet needs highlighted in the report. 

Currently, more 16 million of the 37 million people living with the virus worldwide remain without treatment. Globally, the report notes each week 32,000 new infections and 19,000 people die of AIDS-related illnesses. Young women and adolescent girls face 14 times the risks of infection compared to those around them. Diagnosis and treatment remain disproportionately out of reach for children, teenagers, and young adults. Though tuberculosis is a curable illness, it remains the leading killer of people with HIV. 

Africa’s population of people aged 15-24 is on track to double by 2020.  This means tens of millions of young people will enter this age bracket during a time in their lives when they are most at risk for HIV infection. 

The coming youth bulge and the gaps that remain in treatment and prevention services magnifies the pressing need for increased, adequate funding rather than the retreat represented in the White House proposal to cut $1 billion from U.S. global HIV spending. That retreat, as the report notes, risks a rebound of the pandemic that could exceed the global community’s resources to confront, putting millions of more lives at risk. 

We agree with the report that the window of opportunity to end the global public health threat of HIV is narrow. Funding for PEPFAR must increase to preserve the gains we’ve made, and bring them to fruition.


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