The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) - the largest and most successful commitment by any nation to address a single disease in history – must be allowed to continue to empower local partners in Africa, and especially South Africa as the global epicenter of HIV, if the epidemic is to be finally stopped by 2030.   

This was the consensus that among top opinion leaders, civil society groups and politicians from different continents and sides of the aisle, at a gathering hosted by BroadReach Group (https://BroadReachCorporation.com/) at the National Press Club in Washington, D.C. earlier this week (September 12th) to celebrate PEPFAR’s achievements over the past 20 years and to advocate for its reauthorisation – so that the job of saving millions of African lives and ending HIV as a public health threat could be completed.  

PEPFAR currently supports life-saving antiretroviral treatment for over 20 million adults and children in Africa and beyond and has in 20 years helped save 25 million lives globally, according to PEPFAR statistics (https://apo-opa.info/3EHHiqP).  

BroadReach is a local South Africa implementation partner for PEPFAR, running the second largest HIV treatment and care programme globally, in partnership with the local departments of health in KwaZulu-Natal and Mpumalanga. “As a local South Africa organisation, we hosted this event to both express our gratitude to PEPFAR for their ongoing support and to also put a tangible, human face to the programme as we join the global development community in advocating for reauthorisation,” said Chris LeGrand (https://apo-opa.info/48mvoQQ), CEO BroadReach Group.  

Current PEPFAR acting leader, Dr Rebecca Bunnell (https://apo-opa.info/3PGvXxk) commented that everyone who was there in the early days of HIV and AIDS experienced post-traumatic stress when thinking back to the days before PEPFAR entered the fight. BroadReach co-founder Dr Ernest Darkoh concurred as he reflected on the early 2000s: “People were coming to hospitals by the thousand, thin, emaciated and with no hope, and today thanks to empowered and funded local programmes this is no longer the case. Life-saving treatment is readily available and people can lead long and healthy lives.” 

Key US and African figures who have championed, shaped and shepherded the global response to the HIV epidemic took to the stage to advocate for reauthorisation and to share why PEPFAR is so important. Delegates included senior representation from PEPFAR, the South African AIDS Council, UNAIDS, USAID, Microsoft AI for Health, Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, and various decision-makers from the US government. 

Former House Foreign Affairs Committee Chairman Ed Royce, who previously chaired the Africa sub-committee when PEPFAR was last authorised, said PEPFAR was “the most consequential and successful foreign aid programme in history”. He explained that through the networks and training set up within PEPFAR global health systems have become more resilient to shocks: “Thanks to this programme we knew how to deal with Ebola (and COVID), and therefore we also know what the consequences will be if we don’t move forward with this reauthorisation,” said Royce, a Republican. 

Democratic Congresswoman Barbara Lee of the US House of Representatives, a fervent advocate for PEPFAR who authored or co-authored all recent critical HIV legislation in the US, and visited several African countries over the past 20 years to ensure local needs were met and local capacity was built by PEPFAR, called for a politically clean reauthorisation. “Let’s get it done and get it to the President’s desk.” 

HIV stalwart, Ambassador Dr Deborah Birx, who led PEPFAR for over eight years, said PEPFAR’s resources and influence were critical for enabling the world to reach its goal to end the spread of HIV by 2030. She spoke to PEPFAR’s successes in building sustainable health systems in developing nations, as seen when US personnel left the continent when COVID hit and local partners, like BroadReach, stayed on the ground to deliver prevention, treatment and care to patients.  

She gave an impassioned plea for reauthorisation: “We have no time to lose and must push to realise the goal of ending HIV as a global public health threat by 2030.” 

Angeli Achrekar (https://apo-opa.info/462IpNW), Deputy Executive Director for the Program Branch at UNAIDS, said achieving the 2030 goal required greater inclusion of the most vulnerable, hard-to-reach key populations in all HIV prevention, diagnostics, treatment and care programmes. “We need to keep up a multisectoral partnership approach and maintain the gains of the past 20 years, especially the locally led ones. This includes scaling innovations and community outreaches. It was a long road to reach truly global development and advocacy for HIV, and we must keep up the good work.” 

Achrekar said it was important to note that out of all 17 of the United Nations’ Sustainable Development Goals (SDGs) for 2030, SDG 3.3 (communicable diseases) was the only one where real progress had yet been made. This was largely thanks to the highly effective local responses to HIV that were made possible by PEPFAR’s resourcing all around the world over the past two decades. “These gains are having a knock-on effect in other areas too like gender equality and economic growth.” 

Dr Rebecca Bunnell, who is designated by Dr John Nkengasong to lead PEPFAR laid out the initiative’s five pillar strategy so that HIV could be ended as a public health crisis by 2030, which would lead to a more secure world.  Bunnell said HIV could be contained if supported programmes in partner countries – especially in Africa - could sustain viral load suppression, if they had the capability to prevent, detect and respond to new cases and outbreaks, and if all countries ended or reduced the inequities that drive HIV.  

Han Kang (https://apo-opa.info/44Xjda0), USAID Deputy Assistant Administrator (Acting) for Global Health, and Director of USAID Office of HIV and AIDS, further underscored the agency’s commitment to locally lead programs when she said, “I am delighted to share that earlier today [12 September] we launched a new research and development activity where we are directly funding African based scientists to do vaccine research and development and in particular in South Africa with the Medical Research Council.” 

Dr Ernest Darkoh, BroadReach co-founder who served on President Obama’s Presidential Advisory Council on HIV/AIDS and is now based in Cape Town, said: “One of our greatest joint achievements (of BroadReach, PEPFAR and USAID) was turning around the Ugu District in KwaZulu-Natal which at one point had the highest HIV prevalence in the world. Millions of lives were saved by our health workers, whose capacity was extended with the help of artificial intelligence (AI).” 

Additionally, Dr Bill Weeks, who runs Microsoft’s AI for Health programme, as part of the wider AI for Good initiative, said technology has and would continue to play a vital role in building greater capacity for stretched health systems and healthcare workers. Importantly, technology needed in-built ethical guardrails to ensure that while AI is used, patient confidentiality, privacy and security are always protected. 

Dhirisha Naidoo, who leads BroadReach’s largest HIV treatment and care programme in South Africa, funded through PEPFAR and USAID, reminded the audience of luminaries and stalwarts just how far the development community had come. She reflected on her early career as a nurse 20 years ago in a PEPFAR funded HIV clinic in Kwa-Zulu Natal – where people where emaciated and dying until ARV therapies became available. “Ugu became the first district in SA to reach the 90-90-90 UNAID care and treatment goals. We are proud that just last week two more of our districts have also reached this milestone! We currently support 555 000 people on sustained treatment across four rural, high prevalence districts in Kwa Zulu-Natal and Mpumalanga. Thanks to PEPFAR and USAID, you have given people like me the opportunity to make a difference in my country.” 

Chris Collins, President and CEO, Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, said it was important to continue rallying advocacy support to finish what was started by PEPFAR.  

“It is unfair that people die around the world because of a lack of access to lifesaving drugs. For the global community to reach its goal of ending HIV as a public health crisis by 2030, we must continue to advocate for universal access to healthcare and the achievement of greater diversity, equity and inclusion in global healthcare. This will be possible if PEPFAR is reauthorised and given the green light to scale its innovations and networks to reach more people.”