Removing the Roadblocks: What Happens After PEPFAR’s 1-Year Reauthorization

Written by: Katie Coester, GAPP Co-Chair

After months of defending the President’s Emergency Plan for AIDS Relief (PEPFAR) against baseless attacks, the effort to reauthorize the program ended less than ideally, but as well as might be expected. In April, Congress approved a one-year reauthorization for the initiative which has, to date, saved 25 million lives. Advocates do not view this as the end of the road, but merely a milestone along the way. Securing a multi-year authorization in 2025 is still our goal; we cannot allow a one-year authorization to become a pattern.

A multiyear reauthorization is necessary for many reasons. It ensures stability, demonstrates our commitment to partners, and enables the type of long-term plans and agreements that have helped make the program so successful. On the flip side, the lack of a five-year authorization creates an unnecessary sense of uncertainty.

PEPFAR has always benefitted from broad, bipartisan Congressional support and, with the exception of a few very vocal outliers, it still does. We can all agree that the current political environment is unlike any we’ve seen before. The passage of any authorization in this atmosphere shows just how valued the program is across the political spectrum. There is no sense that support for PEPFAR is waning on Capitol Hill.

That said, a refresher on the program’s history and impact wouldn’t hurt. Few members who were involved in PEPFAR’s creation remain in Congress today. Only about 10% of those who were in office when the program was originally authorized in 2003 will still be in office after this year’s elections. And, one of the program’s most stalwart supporters, Representative Barbara Lee, is leaving at the end of this term. Her departure is a huge loss; she is an incredible champion in the fight against HIV/AIDS, having authored or co-authored every major piece of HIV/AIDS legislation. She is also the co-founder and co-chair of the HIV/AIDS Caucus. Though hers are enormous shoes to fill, there are people — from both sides of the aisle — who are ready to step up; Members of Congress who understand the importance of PEPFAR and the continued urgency in the global AIDS response. But there are many newer Members who are not as well aware. 

We have one year to educate them on PEPFAR and how essential a multi-year authorization is.

There is no other disease program that rivals PEPFAR’s scale and focus. It is incredibly effective and efficient, making the most of the resources it receives. Despite being essentially flat funded for over a decade, it has continued to achieve remarkable progress. Through innovative, targeted, and science-based HIV prevention and treatment programming, it has saved millions of lives, helped stabilize nations through health infrastructure investments, and fundamentally changed the course of the HIV pandemic. Today, 28.7 million people are accessing life-saving treatment and new HIV infections have been reduced by 54% since the peak of the epidemic in 1996. And, though it's a single disease program, PEPFAR’s impact stretches well beyond HIV. The investments made in the program have far reaching effects into education, economic growth, and the world’s perception of the United States.

 PEPFAR is able to measure impact in a way that most other programs cannot. It provides complete transparency around the number of people reached with testing and treatment, and how many people are adhering to treatment. It is able to report on exactly how many lives have been saved through its efforts. In an environment where budget negotiations are fraught, to say the least, these metrics are a uniquely valuable aid in decision making.

 It's important to remember, too, that AIDS is still very much an epidemic. Women and girls in sub-Saharan Africa are disproportionally impacted; of the 4,000 women and girls who become infected with HIV every single week, 3,100 are in this region. HIV-related deaths among children and adolescents have been stubbornly slow to decline. Almost 800,000 children living with HIV are not on treatment; without it, half will die before their second birthday.

 And, let’s remember the painful lesson COVID-19 taught us – an epidemic anywhere is an epidemic everywhere.

 Without a doubt, the most profound PEPFAR learning experience anyone could have is visiting one of its sites. I have never met anyone who has done so and not been forever changed. In the coming year, I encourage Members of Congress and other policy makers to take the time to see this for themselves; to see the real world impact of this one-of-a-kind American investment. They will meet individuals and families with incredible stories, people who believed they would die from AIDS decades ago but who are alive and thriving today. They will see communities with economic opportunities that would not have existed without PEPFAR’s presence. And they will learn that there are places in the world where “PEPFAR” is synonymous with “the U.S.”; their positive view of our country is based largely on their experience with the program.

Certainly, a one year reauthorization of PEPFAR is far from ideal. But if advocates were energized before this, that energy is increased a thousand-fold now. Ours is a very wide tent and includes organization from across the ideological continuum. But we are all united in our efforts to secure a multiyear authorization in 2025. The conversation is far from over; it will stop only when all the roadblocks to PEPFAR’s progress have been removed.