Recently, we marked the 40th anniversary of the first reported cases of HIV in the United States. In the years that followed that initial discovery, HIV emerged as a global health threat; one that would test the commitment of the global community. Now, decades of hard-fought progress are in peril as another pandemic has the world in its grip.
But we must be able to address HIV and COVID-19 at the same time and not allow the deep disruption of COVID to unravel all that we’ve achieved. Doing so requires having the right tools in place: infrastructure, leadership, funding, and reach.
In 2003, the U.S. stepped up as a global leader in the HIV response, launching the President’s Emergency Plan for AIDS Relief. PEPFAR is the largest commitment by any nation to address a single disease in history. Since its inception, through innovative, target-driven and science-based HIV prevention and treatment programming, PEPFAR has saved millions of lives, helped stabilize nations through health infrastructure investments, and fundamentally changed the course of the HIV pandemic.
In the face of the COVID-19 pandemic, PEPFAR has been instrumental in helping countries prepare for effective vaccine delivery, strengthening surveillance and case finding systems, and providing critical laboratory and supply chain capacity. It has deployed medical personnel and commodities and leveraged its expertise in rapidly coordinating with governments and other stakeholders to aid national COVID responses.
Leveraging PEPFAR-supported infrastructure is essential to combating COVID-19 as well as future pandemics. It’s important to bear in mind, however, that doing so cannot happen to the detriment of the fight against HIV/AIDS. We must be able to do several things at once: combat COVID-19, prepare for future pandemics and allow for expanded HIV programming.
Despite its extraordinary success and critical role in fighting current and future pandemics, PEPFAR has been under interim leadership for more than seven months.
At the United Nations High Level Meeting on HIV and AIDS in June, the Biden administration stated: “To end HIV/AIDS by 2030, we need bold leadership. […] Political commitment to ending AIDS matters.” While meeting the 2030 goal is possible, doing so will require strong stewardship by way of a Senate-confirmed leader. Nominating a bold, innovative Global AIDS Coordinator who is committed to transparent and responsive programming must be an urgent priority for the Biden administration.
In addition, PEPFAR has also been consistently flat funded for over a decade. Limited resource growth threatens the agency’s ability to scale up effective programs, invest in new innovations and initiatives, swiftly respond to changing dynamics, prevent new infections and, most importantly, save lives. While the House Foreign Operations, and Related Programs committee provided a $150 million increase in funding for the agency, increased strategic investment will be needed to reach the 2030 finish line.
Ending HIV/AIDS as a public health threat is made much harder by the structural inequalities, stigma and human rights violations that continue to exacerbate the vulnerabilities of marginalized communities. These same populations are facing further setbacks due to COVID-19, with the specialized services that they depend on reduced or closed altogether during lockdowns.
Stay-at-home orders, travel disruptions, and fear of COVID infection left many unable or afraid to get to health centers for testing and treatment. Lockdowns, curfews, economic restrictions and social isolation associated with the pandemic are having a disproportionately negative effect on vulnerable populations. Although this trend predates COVID, 65 percent of new HIV infections in 2020 occurred among key populations. And, while some countries begin to experience a post-vaccine life, many places – often, in extremely resource limited settings – are in the midst of another intense wave of the disease with very little, if any, access to vaccines.
Children and adolescents have suffered heavily. Even prior to COVID-19 imposed disruptions, 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. Worryingly, pediatric access to lifesaving medicines actually declined in 2020.
So, while the tools to end AIDS exist, for many they are unobtainable without bold support from dedicated leadership. A world without HIV requires equal access to services for all, regardless of gender, sexuality, age or geographic location. If the parallel pandemics of HIV and COVID-19 have taught us anything, it is that we cannot win anywhere without reaching everyone in need everywhere.
Facing these challenges requires building on the transformational success of PEFPAR. It is a shining example of U.S. global leadership and true bipartisanship, spanning three presidential administrations. This leadership is vital in U.S. efforts to advance global health security.
Reaching the 2030 deadline is possible. But without the necessary resources and stewardship, PEPFAR will be hard pressed to finish the fight against HIV or provide critical assistance to address COVID-19. We cannot lose focus. And we cannot jeopardize the impact of PEPFAR, one of the most critical and effective programs we have in this fight.
Kevin Robert Frost is the CEO of the American Foundation for AIDS Relief (amfAR); Chip Lyons is president and CEO of the Elizabeth Glaser Pediatric AIDS Foundation.
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