PEPFAR

Global partners that are committed to ending paediatric AIDS have come together to call on countries to rapidly scale up access to optimal, child-friendly HIV treatment for infants and children. The partners include the United Nations Children’s Fund, the World Health Organization (WHO), UNAIDS, the United States President’s Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria, Unitaid, the Elizabeth Glaser Pediatric AIDS Foundation, and the Clinton Health Access Initiative (CHAI).

Children living with HIV continue to be left behind by the global AIDS response. In 2019, only 53% (950 000) of the 1.8 million children living with HIV (aged 0–14 years) globally were diagnosed and on treatment, compared to 68% of adults. [1] The remaining 850 000 children living with HIV have not been diagnosed and are not receiving life-saving HIV treatment. Two thirds of the missing children are aged 5–14 years and do not routinely attend traditional health facilities. Engaging communities and the families of people living with HIV, tuberculosis and other related diseases and offering family services are needed in order to find and start on treatment those missing children.

An estimated 95 000 children died of AIDS-related illnesses in 2019, in part due to lack of early diagnosis of HIV among infants and children and immediate linkage to optimal HIV treatment regimens. Untreated, 50% of infants infected with HIV during or around the time of birth will die before the age of two years. [1]

The United States Food and Drug Administration recently gave tentative approval for the first generic formulation of dolutegravir (DTG) 10 mg dispersible tablets. [2] This approval was the result of an innovative partnership between Unitaid, CHAI and ViiV Healthcare, together with generic suppliers, which accelerated the timeline of development by several years. The approval was quickly followed by the announcement on World AIDS Day of a groundbreaking agreement negotiated by Unitaid and CHAI that reduces the cost of HIV treatment by 75% for children in low- and middle-income countries, where the DTG 10 mg dispersible tablets will be available at a cost of US$ 4.50 for a 90-count bottle. [3] 

This now means that WHO-recommended, preferred first-line DTG-based antiretroviral treatment is now available in more affordable and child-friendly generic formulations for young children and infants as young as four weeks of age and weighing more than 3 kg. [4]  Rapid transition to this treatment, in combination with improved HIV diagnosis for children and other supportive measures, will help to urgently reduce the 95 000 preventable AIDS-related deaths in children.

DTG-based HIV treatment leads to better outcomes for children. DTG is less likely to be affected by drug resistance and achieves viral load suppression sooner; child-friendly dispersible tablets improve adherence due to a lower pill burden and being easier to administer. These factors help children achieve and maintain viral load suppression, the gold standard for measuring the effectiveness of HIV treatment. DTG-based treatment is the standard of care for adults. Starting on this regimen from infancy reduces the need for changes in treatment as they mature through childhood, adolescence and adulthood. Fewer regimens and regimen changes simplifies management of health care, improves stock management and reduces wastage. 

WHO has recommended DTG-based HIV treatment for all infants and children since 2018 [4] and provided dosing recommendations for infants and children over four weeks of age and more than 3 kg in July 2020. [5]

Suppliers have indicated their ability to meet global scale-up ambitions. Accurate forecasts of demand are critical to inform production planning and delivery timelines. It is therefore critical that national programmes start including DTG 10 mg dispersible tablets in their new procurement plans, review stocks and orders for existing non-DTG treatment for children, share forecasts with HIV treatment procurement partners and suppliers and place orders as early as possible.

The partners are committed to support national governments as they develop rapid transition plans from existing suboptimal HIV treatment to DTG-based treatment for infants and children, including advocacy for political commitment, mobilizing international and domestic resources, new policies and guidelines, managing medicine supply, distribution and stock, training health-care workers and sensitizing and engaging affected communities to ensure demand and treatment literacy for children living with HIV and their caregivers in order to ensure rapid uptake of these new formulations.

Further guidance for national programmes and partners is available from WHO. [5] The CHAI HIV New Product Introduction Toolkit has dedicated resources to help countries transition to paediatric DTG. [6]

Quotes from partners

“National governments, partners on the ground and affected communities need to work together to find and treat the children and infants whose lives can be saved by these new medicines,” said Shannon Hader, UNAIDS Deputy Executive Director for Programme. “The new medicines are cheaper, more effective and more child-friendly than current treatments for infants and young children. We need to get them into clinics to save lives now.”

“The United States President’s Emergency Plan for AIDS Relief works tirelessly to ensure clients can access the best available HIV treatment, including advanced, paediatric regimens for children living with HIV,” said Deborah L. Birx, United States Global AIDS Coordinator and United States Special Representative for Global Health Diplomacy. “The accelerated introduction and expansion of paediatric DTG has the potential to save and improve the lives of thousands of children around the world. The United States President’s Emergency Plan for AIDS Relief will continue to collaborate with global and local partners to ensure the young children we serve can promptly access paediatric DTG.”

“Providing antiretroviral drugs to people living with HIV is at the core of our support to national HIV programmes,” said Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. “This new and affordable child-friendly HIV treatment is a tremendous step forward that will improve and save the lives of some of the most vulnerable in society—young children infected with HIV. We are committed to support countries to make a fast transition to these new drugs.”

“Children in low- and middle-income countries often wait years to access the same medications as adults, hindering their quality of life, or even resulting in preventable deaths. We are proud to have worked with partners on this groundbreaking agreement that will bring quality assured dispersible DTG to children at a record pace,” said Philippe Duneton, Unitaid Executive Director. “Ensuring access to this treatment will transform the lives of children living with HIV, helping them to remain on treatment and saving thousands of lives.”

“For the first time, children living with HIV in low- and middle-income countries will have access to the same first-line antiretroviral medication at the same time as those in high-income countries,” said Iain Barton, Chief Executive Officer of the Clinton Health Access Initiative. “The partnership should serve as a model to remove barriers that hinder development of paediatric formulations to deliver top-line medications quickly and affordably.”

“The persistent treatment gap between adults and children prevents us from achieving an AIDS-free generation,” said Chip Lyons, President and Chief Executive Officer of the Elizabeth Glaser Pediatric AIDS Foundation. “Children living with HIV around the world urgently require age-appropriate, effective and accessible formulations. Approval of dispersible DTG is a momentous step forward, but meaningless if this new formulation doesn’t quickly reach the babies and small children who desperately need it most. The Elizabeth Glaser Pediatric AIDS Foundation is committed to supporting accelerated roll-out, uptake and delivery of new, optimal paediatric antiretroviral medicines in partnership with global, regional and local leaders.”

“The persisting treatment gap between mothers and children is unacceptable with the new scientific breakthroughs that are within our reach to change the trajectory”, said Chewe Luo, Associate Director and Chief of HIV, United Nations Children’s Fund. “The United Nations Children’s Fund welcomes global commitments and progress made in developing better diagnostic approaches and optimal regimens for children to improve their outcomes.”

“This has the potential to be a true game-changer for children with HIV", said Meg Doherty, Director of Global HIV, Hepatitis and STI Programmes at WHO. “We must do all in our power to help countries get this new paediatric DTG 10 mg to all the children who need it."

[1] UNAIDS. Start Free Stay Free AIDS Free - 2020 report. 07 July 2020. https://www.unaids.org/en/resources/documents/2020/start-free-stay-free-aids-free-2020-progress-report

[2] https://www.accessdata.fda.gov/drugsatfda_docs/pepfar/214521PI.pdf

[3] UNITAID press release. Groundbreaking Agreement Reduces by 75% the Cost of HIV Treatment for Children in Low-and Middle-Income Countries. https://unitaid.org/news-blog/groundbreaking-agreement-reduces-by-75-the-cost-of-hiv-treatment-for-children-in-low-and-middle-income-countries/#en 

[4] World Health Organization. Updated recommendations on first-line and second-line antiretroviral regimens and post-exposure prophylaxis and recommendations on early infant diagnosis of HIV. Interim guidance. 1 December 2018, https://www.who.int/publications/i/item/WHO-CDS-HIV-18.51.

[5] World Health Organization. Considerations for introducing new antiretroviral drug formulations for children. Policy brief. 1 July 2020, https://www.who.int/publications/i/item/9789240007888.

[6] Clinton Health Access Initiative. HIV new product introduction toolkit. Pediatric 10 mg dispersible, scored resources, https://www.newhivdrugs.org/.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

As global 2018 targets are unmet, Start Free, Stay Free, AIDS Free report shows that efforts need to focus on the countries falling behind

GENEVA/MEXICO CITY, 22 July 2019—A new report released today at the 10th  IAS Conference on HIV Science in Mexico City, Mexico, shows that the world is lagging behind in its commitment to end the AIDS epidemic among children and adolescents. The report, Start Free, Stay Free, AIDS Free, shows that the pace of progress in reducing new HIV infections among children and expanding access to treatment for children, adolescents and pregnant women living with HIV has slowed significantly and that global targets set for 2018 have been missed, despite important gains being made in some countries.  

Globally, around 160 000 children aged 0–14 years became newly infected with HIV in 2018. This is a major decrease from 240 000 new infections in 2010. However, the bold and important target set for 2018 was fewer than 40 000 new infections.

“The failure to reach the 2018 targets to reduce new HIV infections among children and adolescents and to widen access to life-saving treatment is both disappointing and frustrating,” said Gunilla Carlsson, UNAIDS Executive Director, a.i.  “We need to act quickly to turn this situation around and honour the commitment to end the AIDS epidemic for the next generation.”

Around 82% of pregnant women living with HIV now have access to antiretroviral medicines. There has been considerable progress among countries in eastern and southern Africa, with more than 90% of pregnant women accessing antiretroviral medicines in Ethiopia, Kenya, Uganda, United Republic of Tanzania and Zimbabwe and 95% or higher in Botswana, Malawi, Mozambique, Namibia and Zambia. This has resulted in a 41% reduction in new HIV infections among children, with remarkable reductions achieved in Botswana (85%), Rwanda (83%), Malawi (76%), Namibia (71%), Zimbabwe (69%) and Uganda (65%) since 2010. The progress made by these countries shows what can be achieved through strong political leadership, rapid policy adoption and concerted efforts by all stakeholders.

The report throws light on where gaps need to be filled to prevent new HIV infections occurring among children. For example, in eastern Africa, 10 000 of 26 000 new HIV infections among children in 2018 were the result of women not being retained on treatment throughout pregnancy and breastfeeding. In southern Africa, 17 000 of 53 000 new infections among children were the result of the mother becoming infected with HIV during pregnancy or breastfeeding. A total of 16 000 new infections could have been averted in southern Africa by retaining mothers on treatment throughout pregnancy and breastfeeding. In western and central Africa, almost 27 000 of the 44 000 new infections could have been averted if their mothers had accessed antiretroviral medicines.

“These new data show that many countries have made important progress toward reaching the 2020 targets, and yet others are lagging significantly behind,” said Deborah Birx, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy. “These stark disparities highlight the critical role of political commitment, rapid policy implementation and data-driven investments in accelerating impact.”

Country-level analysis of how mother-to-child transmission of HIV happens can provide vital information to shape national responses.

“Ending AIDS and achieving universal health coverage means leaving no one behind. Yet, too many children and adolescents with HIV are still missing out on the chance to grow up in full health as they can’t access treatment,” said Ren Minghui, the World Health Organization’s Assistant Director-General for Universal Health Coverage/Communicable and Noncommunicable Diseases. “We need to intensify our efforts to and keep our promise to these children.” 

Children living with HIV are also being left behind in HIV treatment scale-up and are not being diagnosed and treated early enough. An estimated 940 000 children aged 0–14 years were accessing treatment in 2018, double the number that were on treatment in 2010 but far short of the target of 1.6 million set for 2018.

Children living with HIV are still less likely to have access to HIV treatment than adults living with HIV, a disparity that is widening in some countries, especially in western and central Africa. As a result, the AIDS epidemic is still claiming the lives of many children aged 0–14 years. Children in this age group comprised 5% of all people living with HIV in 23 focus countries but accounted for 15% of people who died from AIDS-related illnesses in those countries in 2018. 

"We know how to prevent children from contracting HIV, and we know how to prevent the onset of AIDS in children if they do become infected. They need to be tested and linked to care and treatment as a matter of urgency, but we are missing these opportunities,” said Henrietta Fore, Executive Director of the United Nations Children’s Fund. “Knowing what to do is not enough. We must come together and act with renewed commitment to children and adolescents living with HIV and give them the best chance to survive and thrive.”    

For optimal outcomes, children who become infected with HIV must access treatment as quickly as possible. However, in 2018, only 63% of the 1.1 million infants exposed to HIV in the 23 countries worst affected by the epidemic were tested for HIV by the age of two months.

“In many ways, we as a community have settled for a substandard quality of care for children living with HIV,” said Chip Lyons, President and Chief Executive Officer, Elizabeth Glaser Pediatric AIDS Foundation, “We must not allow children to perpetually receive less than the basic standard of care we demand for adults. Especially when the ultimate consequence of that approach is that children and young people are dying of HIV at disproportionally and unacceptably high rates.”

The report also shows that the target of reducing the annual number of new HIV infections among young women and adolescent girls aged 15–24 years to less than 100 000 by 2020 is unlikely to be reached. Globally, new HIV infections among young women and adolescent girls were reduced by 25% between 2010 and 2018, to 310 000. While new HIV infections among adolescent girls and young women aged 15–24 years have declined by over 40% in Botswana, Burundi, Lesotho and South Africa, missing the global target has meant that 6000 adolescent girls and young women are still becoming infected with HIV every week.

The root factors driving the vulnerability of young women and girls to HIV infection are social, structural and behavioural and must be addressed in order to achieve sustainable prevention outcomes. Gender discrimination, gender-based violence, restricted access to opportunities and a lack of tailored services all compound their vulnerability to HIV. Effective responses prioritize an approach combining access to HIV and sexual and reproductive health services with social, structural and behavioural programmes.

“The disparity in viral load suppression rates among adolescents with HIV compared to adults is unacceptable and behoves the global community to advocate for more robust, potent antiretroviral therapy regimens for adolescents as well as to hasten efforts to prevent new infections in this critically vulnerable population,” said Fatima Tsiouris, Deputy Director of the Clinical and Training Unit and Prevention of Mother-to-Child Transmission Lead at ICAP, Columbia University.

The number of voluntary medical male circumcisions undertaken between 2015 and 2018 stood at over 11 million among all age groups, which means that at least 13 million procedures need to be carried out by 2020 in order to reach the target of voluntarily circumcising 25 million men and boys between 2015 and 2020.

UNAIDS and the United States President’s Emergency Plan for AIDS Relief launched the Start Free, Stay Free, AIDS Free framework in 2016 to build on the achievements of the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive, which ended in 2014.      

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Faith-based organizations have long played a critical role in the response to tuberculosis (TB). Many faith-based health service providers have implemented effective TB/HIV responses modelled on decades of work on TB. Today, faith-based organizations are delivering effective, high-quality TB/HIV services that complement national public health programmes in the countries most affected by TB and HIV.

Successful TB/HIV responses address both the biomedical and the social determinants that underpin these illnesses, such as poverty, inequality, situations of conflict and crisis, compromised human rights and criminalization. Children and adolescents are particularly vulnerable to infection and the impact of TB/HIV on their families. Because they have positions of trust at the heart of communities, faith-based organizations can provide services and support that extend beyond the reach of many public sector health systems.

To provide an opportunity to strengthen relationships and forge new partnerships, on 27 September the World Council of Churches–Ecumenical Advocacy Alliance, in collaboration with UNAIDS, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the United Nations Interagency Task Force on Religion and Development, hosted an interfaith prayer breakfast on the sidelines of the 73rd Session of the United Nations General Assembly in New York, United States of America. Keynote speakers and table discussions focused on the outcomes of the United Nations High-Level Meeting on Tuberculosis, which took place on 26 September, and examined how the longstanding experience of faith-based organizations in responding to TB/HIV can support the new declarations agreed by Member States during the historic high-level meeting.

The participants included faith leaders and health service providers from different religious traditions. Survivors of multidrug-resistant TB brought a powerful sense of urgency and reality to the discussion. The participants renewed their call to national governments to not only maintain, but increase, support in order to end AIDS and TB as public health threats by 2030.

First announced during the 2003 State of the Union Address by the then President, George W. Bush, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) is celebrating its 15th anniversary in 2018. Over the past 15 years, PEPFAR has dramatically changed the landscape of the global response to HIV, and bipartisan support across successive administrations since its launch has continued to ensure that PEPFAR expands it work towards controlling the AIDS epidemic.

Launched with an initial budget of US$ 15 billion over its first five years, PEPFAR has gone on to commit US$ 70 billion to the AIDS response. The funding has had remarkable results: in 2017, PEPFAR was supporting 13.3 million of the 21.7 million people living with HIV on treatment, including 1 million children, and in May 2018 announced that more than 14 million were on treatment.

PEPFAR has funded major HIV prevention programmes. The preventative effect of voluntary medical male circumcision on HIV transmission has been ramped up by funding more than 15.2 million circumcisions since 2003. Prevention of mother-to-child transmission of HIV services have ensured that 2.2 million babies have been born HIV-free, while 85.5 million people have accessed HIV testing services, allowing the people taking the tests to start on treatment or access HIV prevention services to stay HIV-free.

PEPFAR’s work with children orphaned or otherwise made vulnerable by HIV resulted in more than 6.4 million children being supported by PEPFAR in 2017, while the PEPFAR DREAMS programme saw new HIV infections among adolescent girls and young women drop by 25–40% in those locations in which the programme was implemented.

On 27 September PEPFAR published its 2018 progress report, showing the progress made one year into its 2017–2020 strategy. PEPFAR supports the AIDS response in 53 countries—of those, 13 are already on track to control their HIV epidemics by 2020, while many more could still do so through scaling up resources and policies to ensure access to HIV prevention and treatment services.

“The contributions of PEPFAR have transformed the lives of people living with or affected by HIV around the world,” said Michel Sidibé, Executive Director of UNAIDS. “We are very proud of our longstanding partnership and look forward to continuing to work closely together to deliver results for men, women and children, particularly the most marginalized.”

A new US$ 30 million partnership to help end cervical cancer led by the United States President’s Emergency Plan for AIDS Relief (PEPFAR), the George W. Bush Institute and UNAIDS will accelerate life-saving efforts in eight African countries.

Studies show that women living with HIV are four to five times more likely to develop invasive cervical cancer. However, the disease is preventable through screening and early treatment of precancerous lesions. Early detection and treatment of cervical cancer can dramatically increase a woman’s chance of survival—women with preinvasive lesions have a five-year survival rate of nearly 100%.

Because of the high prevalence of HIV in sub-Saharan Africa, and because women in sub-Saharan Africa are not screened or treated as early or frequently as women in other parts of the world, cervical cancer remains the number one cancer killer of women in the region.

To address the disproportionate risk of cervical cancer among women living with HIV and the need for increased rates of screening and treatment in sub-Saharan Africa, PEPFAR the George W. Bush Institute and UNAIDS recently announced a new partnership—the Partnership to End AIDS and Cervical Cancer—designed to effectively eliminate cervical cancer deaths among women living with HIV in sub-Saharan Africa within a generation. The partnership will build on successful efforts over the past seven years of the Pink Ribbon Red Ribbon initiative and, pending Congressional approval, will be supported by an initial investment of US$ 30 million from PEPFAR.

“When we confront suffering—when we save lives—we breath hope into devastated populations, strengthen and stabilize society, and make our country and the world safer,” said President George W. Bush. “This week, we are announcing the next phase of our partnership with the United States President’s Emergency Plan for AIDS Relief and UNAIDS: a plan to effectively eliminate cervical cancer amongst HIV-positive women within a generation.”

The partnership will focus its work in eight sub-Saharan African countries where the burdens of HIV and cervical cancer are high—Botswana, Lesotho, Malawi, Mozambique, Namibia, Swaziland, Zambia and Zimbabwe. There are about 6 million women living with HIV in those eight countries. More than 100 000 women are diagnosed annually with cervical cancer in sub-Saharan Africa.

“The partnership will allow us to screen for, and treat, precancerous lesions among women living with HIV like never before,” said Michel Sidibé, the Executive Director of UNAIDS. “The partnership’s new strategy, which includes cervical cancer screening every two years for women living with HIV over the age of 30 years, aims to reduce cervical cancer incidence by 95% among this population in eight sub-Saharan African countries.”

The partnership will engage with governments in each of the countries to ensure that women and girls living with HIV are a priority in national cervical cancer prevention and control programmes. It will also leverage the powerful advocacy of first ladies, ministers, civil society, global health leaders and funders to improve implementation efforts and speed progress against the goal of eliminating cervical cancer.

“Thanks to the generosity of the American people, the United States President’s Emergency Plan for AIDS Relief has saved the lives of millions of HIV-positive women around the world,” said Deborah Birx, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy. “We must ensure these same women—mothers, daughters, aunts, and grandmothers—who are living with HIV and thriving do not succumb to cervical cancer.”

The new partnership builds on the successful efforts of the Pink Ribbon Red Ribbon initiative. Since its inception in 2011, Pink Ribbon Red Ribbon and its partners have screened more than half a million women for cervical cancer in Botswana, Ethiopia, the United Republic of Tanzania and Zambia, treated almost 32 000 women for precancerous lesions and vaccinated almost 150 000 girls aged 9–13 years against human papillomavirus type 2.

New results from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) announced on World AIDS Day 2017 show strong advances in scaling up HIV prevention and treatment.

UNAIDS recently reported that nearly 21 million people living with HIV are accessing antiretroviral therapy—more than half of the 36.7 million people living with HIV are now on life-saving treatment. PEPFAR’s latest data show that PEPFAR supported more than 13.3 million of those men, women and children.

PEPFAR’s new data also indicate that there have been significant declines in new HIV infections among adolescent girls and young women. In the 63 districts of 10 African countries implementing PEPFAR’s pioneering DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) public–private partnership, the majority (65%) of the highest HIV burden communities or districts achieved a greater than 25% decline in new HIV infections among adolescent girls and young women. ‎Importantly, new HIV infections declined in nearly all DREAMS programme districts.

By the end of September 2017, PEPFAR had provided voluntary medical male circumcision to more than 15.2 million men and boys. This result was reached through the largest single-year increase (3.4 million) in new voluntary medical male circumcisions since the beginning of PEPFAR.

PEPFAR has supported more than 6.4 million orphans and other vulnerable children and their caregivers affected by HIV and has prevented HIV infection among 2.2 million babies born to women living with HIV.

The new data add to PEPFAR’s impact results released in the past year, which show that five African countries are approaching control of their HIV epidemics. They also highlight critical advances being made under the PEPFAR Strategy for Accelerating HIV/AIDS Epidemic Control (2017–2020), which was launched by United States Secretary of State Rex Tillerson at the 2017 United Nations General Assembly.

The Executive Director of UNAIDS, Michel Sidibé, has spoken out about the need for continued leadership in global health from the United States of America to end the AIDS epidemic. During a speech at the Foundation for AIDS Research (amfAR) Capitol Hill Conference, Mr Sidibé said, “What scares me is the move to a conspiracy of complacency. People think that AIDS is done, that we can move on. Now is not the time to lose our momentum.”

Senior United States officials, researchers, implementers, policy-makers and advocates were present at the event, which was held to review the substantial progress in the response and what is required to end the AIDS epidemic by 2030.

The conference, Making AIDS History: a Roadmap for Ending the Epidemic, was chaired by Susan Blumenthal, amfAR’s Senior Policy and Medical Advisor and former United States Assistant Surgeon General. Speakers acknowledged the strong bipartisan commitment and leadership of successive United States Administrations and the Congress, which have saved millions of lives and made it possible to begin envisaging a world without AIDS. It was noted that cuts to international assistance, multilateral organizations and United States global AIDS programmes would have irreversible and devastating consequences.

Deborah Birx, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy, presented data illustrating dramatic results, including progress towards reaching the 90–90–90 targets among adults in Malawi, Zambia and Zimbabwe and corresponding declines in new HIV infections.

“It is remarkable what we have achieved, bringing together governments and communities, with the support of UNAIDS and collaboration with the Global Fund to Fight AIDS Tuberculosis and Malaria,” said Ms Birx. “These essential partnerships make hard-earned United States taxpayer dollars go so much further and amplify our results.”

Mr Sidibé emphasized that partnership and global solidarity are paying off—in both economic terms and in the number of lives that have been saved. “The generosity and compassion of the American people has helped us move from despair to hope,” he said.

Kenneth Cole, Chief Executive Officer of Kenneth Cole Productions, Chairman of amfAR and International Goodwill Ambassador for UNAIDS, referred to commitments made by governments to Fast-Track the response to the epidemic and said that strong, continued United States leadership is essential to seizing the moment and dramatically scaling-up access to HIV treatment and prevention services. “We are at a tipping point and tipping points can go one of two ways—we have to end up on the right side. We have come too far to see 35 years of hard won progress grind to a halt,” said Mr Cole.

UNAIDS is leading global efforts to end the AIDS epidemic and is working with countries, donors, civil society and partners to increase action and Fast-Track the response to HIV over the next four years to end AIDS as a public health threat by 2030. 

Since its establishment in 2003, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) has saved millions of lives. In 2016, around 11.5 million people living with HIV had access to antiretroviral treatment through PEPFAR-funded programmes, including 1.1 million children. Nearly 2 million babies born to women living with HIV were born HIV-free, and 6.2 million orphans and other vulnerable children received care and support.

In addition, PEPFAR funding supported more than 11.7 million voluntary medical male circumcision procedures to help prevent HIV acquisition and one million adolescent girls and young women were reached through the DREAMS initiative in 10 countries in sub-Saharan Africa.

And PEPFAR is on track to continue to deliver yet more results. Through a series of consultations over the past three months, PEPFAR has completed planning for its 2017 funding cycle to support more than 30 countries through Country Operational Plans.

The final regional review meeting in the process—which involved around 250 partners, including senior government officials in implementing countries, civil society representatives and multilateral organizations—concluded on 29 April in Johannesburg, South Africa. UNAIDS Executive Director Michel Sidibé addressed the opening plenary meeting, underscoring the vital role of PEPFAR in accelerating country efforts to control their epidemics and advance towards the goal of ending AIDS by 2030.

PEPFAR’s investments in countries supports UNAIDS’ efforts to Fast-Track the response to HIV. The Fast-Track approach focuses on accelerating scale-up of HIV prevention, treatment, care and support for the populations and locations most affected by the epidemic. The development and review of PEPFAR’s Country Operational Plans is a model for transparency, inclusion and country ownership, with senior government officials and people living with and affected by HIV involved in the process.

UNAIDS is a key partner, working closely with countries to leverage PEPFAR investments and accelerate progress towards prevention and treatment targets. Bringing together the diverse technical resources of the United Nations system, UNAIDS helps countries to strengthen data systems, focus national strategic plans, overcome bottlenecks to scale-up, and put in place an enabling policy and social environment for access to services, including by eliminating stigma and discrimination.