“Sitting in a conference room in the shadow of Mount Kilimanjaro in northern Tanzania, we cautiously asked a group of young Tanzanians who are living with HIV to contemplate the unthinkable: What if PEPFAR ends?
It’s a question many Americans may not have considered. PEPFAR — the President’s Emergency Plan for AIDS Relief — is arguably the U.S. government’s most successful global health program, credited for preventing an estimated 25 million deaths from AIDS since its start in 2003. Now, after decades of wide bipartisan support, the program is in serious danger, as some Republicans in Congress are threatening to hold up its reauthorization over baseless claims it funds abortions.
Those debates seem incomprehensible to the young people with whom we work. For them, PEPFAR has been their lifeline. From the time they were born, many watched their biological mothers die of AIDS. Too many have endured traumatic home transitions, extreme stigma, poverty and hopelessness.
They are the generation PEPFAR sought to save — and it has. U.S. funding has made antiretroviral therapy widely accessible in countries such as Tanzania, turning HIV infection from a near-certain death sentence to a treatable infection that can be successfully managed with medication. PEPFAR has supported education programs to teach people living with HIV that they can keep the virus suppressed, and that they can have children without passing on HIV infection. It has lifted them from suffocating despair and has enabled them to have hope for their future.
There is an expression in Tanzania, “Tumia dawa kutimiza ndoto,” which means, “Take your medicine to achieve your dreams.” This is the contract PEPFAR has offered a generation of Africans living with HIV. But the contract goes both ways. Why would the U.S. government do so much to give these young people hope, only to take it away?” Read more.
Dr. Dorothy Dow and Dr. Blandina Mmbaga penned these words in an opinion piece published last month in The Messenger titled This is Who Will Suffer Most if US AIDS Funding Ends. Dow is an associate professor at the Duke Global Health Institute and the Division of Pediatric Infectious Diseases at Duke University, and Co-Director of the Duke CFAR Clinical Core. She has lived and worked in Moshi, Tanzania, since 2011 and co-developed a program, Sauti ya Vijana, a mental health intervention for youth living with HIV. Mmbaga is a Tanzanian pediatrician and professor who directs the Kilimanjaro Clinical Research Institute. With Dow, she co-leads Duke University’s partnership on global health research and training with the Kilimanjaro Christian Medical Centre in Tanzania.
Last Saturday, the deadline passed for Congress to renew long-term funding for PEPFAR, despite its passage of a spending bill to avoid a government shutdown. While PEPFAR remains funded for now, Congress will need to reauthorize the program in a separate bill for a longer-term extension, and its future is in jeopardy. As Drs. Dow and Mmbaga write, failed reauthorization could threaten the progress made against HIV in sub-Saharan Africa, particularly to protect adolescent girls and young women.
Dr. Chris Beyrer, Associate CFAR Director leading Global HIV efforts at Duke, serves on the PEPFAR Scientific Advisory Board and works closely with the Chief Science Officer, Mike Reid. He shared his praise of PEPFAR’s monumental successes and concern for the future: “The PEPFAR program has had strong bipartisan support for 20 years and through four US administrations—and that is because it has worked: Saving millions of lives, preventing millions of infections, and bringing hope to HIV affected families, communities, and regions. To see the program threatened now by political infighting is tragic—this is too important a program to put at risk.” Dr. John Bartlett, who has spent more than three decades supporting capacity strengthening efforts in Moshi, echoed this sentiment: “The public health benefits and profound impact on the global HIV pandemic are well documented and profound. To withdraw support for such a successful bipartisan program which has created global goodwill toward the United States based on a political falsehood is immoral.”
Learn more about the key facts surrounding PEPFAR reauthorization.
Read the full opinion article by Dow and Mmbaga.