PEPFAR

Despite significant gains in many countries, critical gaps continue to undermine efforts to end AIDS in children

GENEVA/MUNICH, 22 July 2024—Despite progress made in reducing HIV infections and AIDS-related deaths among children, a new report released today by the Global Alliance for Ending AIDS in Children by 2030 shows that an urgent scale up of HIV services in countries worst affected by the pandemic is required to end AIDS by 2030.

The report, Transforming Vision Into Reality, shows that programmes targeting vertical transmission of HIV have averted 4 million infections among children aged 0-14 years old since 2000. Globally, new HIV infections among children aged 0-14 years old have declined by 38% since 2015 and AIDS-related deaths have fallen by 43%.     

Among the 12 Global Alliance countries, several have achieved strong coverage of lifelong antiretroviral therapy among pregnant and breastfeeding women living with HIV, with Uganda nearing 100%, United Republic of Tanzania at 98%, and South Africa at 97%. Mozambique has achieved 90% coverage, with Zambia at 90%, Angola at 89%, Kenya at 89%, Zimbabwe at 88%, and Cote d'Ivoire at 84%.

“I applaud the progress that many countries are making in rolling out HIV services to keep young women healthy and to protect babies and children from HIV,” said UNAIDS Executive Director, Winnie Byanyima. “With the medicines and science available today, we can ensure that all babies are born – and remain – HIV-free, and that all children who are living with HIV get on and stay on treatment. Services for treatment and prevention must be ramped up immediately to ensure that they reach all children everywhere. We cannot rest on our laurels. The death of any child from AIDS related causes is not only a tragedy, but also an outrage. Where I come from, all children are our children. The world can and must keep its promise to end AIDS in children by 2030.”

Global Alliance countries are innovating to overcome barriers and accelerate progress towards ending AIDS in children. However, despite advances neither the world nor Global Alliance countries are currently on track to reach HIV-related commitments for children and adolescents and the pace of progress in preventing new HIV infections and AIDS-related deaths among children has slowed in recent years.

“Accelerating the delivery and uptake of HIV services for children and adolescents is a moral obligation, and a political choice,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “Twelve countries are demonstrating they have made that choice, but significant challenges remain. While we have made progress in increasing access for pregnant women to testing and treatment to prevent vertical transmission of HIV, we are still far from closing the paediatric treatment gap. We need to further strengthen the collaboration and reach of the Global Alliance, and we must do this work with focus, purpose and in solidarity with all affected mothers, children, and adolescents.”

Around 120 000 children aged 0-14 years old became infected with HIV in 2023, with around 77 000 of these new infections occurring in the Global Alliance countries. AIDS-related deaths among children aged 0-14 years old numbered 76 000 globally with Global Alliance countries accounting for 49 000 of these unnecessary deaths. Vertical transmission rates remain extremely high in some locations, particularly in Western and Central Africa, with rates exceeding 20% in countries including Nigeria and the Democratic Republic of the Congo.

“In the fight against HIV, we must do a much better job for children,” said Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which provides funding for HIV programmes in over 100 countries through a country-led partnership model. “In support of national programmes, we have been procuring the latest dolutegravir-based paediatric treatment regimens at negotiated prices. Our investments in laboratory systems are helping ensure exposed infants are rapidly tested and that those that test positive are quickly initiated on age-appropriate antiretroviral treatment. Differentiated testing and treatment approaches are helping close the diagnostic gap and ensuring more child-centred service delivery.”

It is concerning that the treatment gap between adults and children continues to widen.

“Just 57 per cent of children living with HIV receive life-saving treatment, compared to 77 per cent of adults,” said UNICEF Associate Director HIV/AIDS, Anurita Bains. “Without early and effective testing and treatment, HIV remains a persistent threat to the health and well-being of children and adolescents and puts them at risk of death. To close the treatment gap, we must support governments to scale up innovative testing approaches and ensure children and adolescents living with HIV receive the treatment and support they need.”

In 2023, there were 210 000 new infections globally among young women and girls aged 15—24 years old (130 000 in Global Alliance countries), four times higher than the 2025 goal set at 50 000. Preventing new infections among this age group is critical both to protect the health and wellbeing of young women and to reduce the risk of new infections among children.

Gender inequalities and human rights violations are increasing women’s vulnerability to HIV and diminishing their ability to access essential services. Globally, nearly one in three women have encountered some form of violence during their lifetime, with adolescent girls and young women disproportionately affected by intimate partner violence. In the four Global Alliance countries with available data, countries are not currently on track to achieve the target of ensuring that by 2025 less than 10% of women, key populations and people living with HIV experience gender-based inequalities and gender violence.

"It has been remarkable to see how many more children's lives can be saved when all stakeholders and partners come together to commit to end AIDS in children. While much progress has been made, notably through the successful introduction of pediatric dolutegravir, large gaps still remain across the pediatric cascade and we must recommit ourselves with purpose and innovation to fulfill the promises we have made by 2025 and beyond,” said Ambassador John N. Nkengasong, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy.

The Global Alliance for Ending AIDS in Children by 2030 was launched in 2022 by WHO, UNICEF and WHO to reinvigorate the paediatric HIV agenda. It has now grown, and in addition to the United Nations agencies, the alliance includes civil society movements, including the Global Network of People living with HIV, national governments in the most affected countries, and international partners, including PEPFAR and the Global Fund. Twelve countries are members: Angola, Cameroon, Côte d'Ivoire, The Democratic Republic of the Congo (DRC), Kenya, Mozambique, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe.

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.

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.

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.

To mark the 20th Anniversary year of PEPFAR, UNAIDS Executive Director has written a letter to the American people. 

You can read the text of her letter below. Click here to be able to view the actual letter.

Dear American friends,

When AIDS hit Africa it tore my continent. It was said in many communities that every extended family lost someone—it hit my family, too. The U.S. President’s Emergency Plan for AIDS Relief, launched by President George W. Bush, and carried forward by every subsequent President and Congress, has changed that. It has saved millions of lives, pushed back a pandemic, and helped advance economic development and stability. It has shown, too, what it looks like when a country leads by demonstrating the power of compassion and partnership. PEPFAR is the greatest contribution made by any country to ending AIDS. Now, with the end of AIDS achievable this decade, the world needs PEPFAR to finish the job.

I was recently in Washington D.C., where I met with passionate activists from across America. They were there to advocate for the inspirational work of PEPFAR in meetings with members of Congress. Americans are rightly proud of PEPFAR’s contribution to the health and development of tens of millions of people around the world.

In the last 20 years, the U.S. Government has invested more than US$110 billion to support the response to HIV and AIDS in 55 low and middle-income countries with the highest burden of HIV. The results that PEPFAR has helped make possible are remarkable—the rate of new HIV infections has fallen by almost half, AIDS-related deaths have been reduced by two thirds, and three-quarters of people living with HIV are on life-saving medicine. Millions of deaths have been prevented, and millions of babies have been born HIV-free.

Through the global HIV response, PEPFAR’s work has strengthened health and community systems, delivering broader outcomes for health, economic and human development and equity, accelerating progress towards achievement across the Sustainable Development Goals. Annually, PEPFAR has provided support and services through more than 70 000 facility and community health clinics; 3000 laboratories and nearly 30 national reference laboratories, as well as more than 340 000 health care and community workers. PEPFAR’s investment in health systems contributes significantly to national surveillance and health information capacities, which were critical to national COVID-19 responses and remain crucial for managing future pandemics and other public health threats.

PEPFAR has demonstrated the invaluable role of community engagement and civil society for advancing health and sustainable development, from helping faith-based organizations providing essential HIV care and support services across Africa, to ensuring support for Ukrainian civil society as the front-line of the national HIV response throughout the war.

As an important part of U.S. diplomacy, PEPFAR’s unflinching commitment to stand up against discrimination and inequities in HIV services sends a powerful signal that the world needs to ensure that nobody is left behind if we are to end AIDS.

PEPFAR works through partnerships. I look forward to my upcoming joint mission in Africa with PEPFAR and the Global Fund. At UNAIDS, which works on the ground in over 90 countries, including all 55 PEPFAR partner countries, we see the difference PEPFAR makes every day.

Twenty years ago, President Bush launched the creation of PEPFAR by announcing that “seldom has history offered a greater opportunity to do so much for so many”. In 2003, U.S. Congress moved swiftly to authorize PEPFAR within weeks. PEPFAR legislation was reauthorized in 2008, 2013 and 2018, with the bipartisan leadership and support of the U.S. Congress. With the lives of tens of millions of people hanging in the balance, countries, communities and UNAIDS are confident that we can rely on the American people, and that the U.S. Government and the U.S. Congress will continue to demonstrate unparalleled leadership through support for PEPFAR.

What was once a dream, but which PEPFAR’s partnership makes possible—the end of AIDS by 2030—is a reflection of the values of the American people. So today I wanted to write to you to say Thank You.

Yours,

Winnie Byanyima

UNAIDS Executive Director

Under-Secretary-General of the United Nations

Although great strides have been made in tackling HIV in recent years, Africa remains the continent most affected by HIV and progress towards ending AIDS is stalling. The COVID-19 pandemic, global inflation, growing debt levels, and a retreat from overseas development assistance by some donors are hampering Africa’s efforts to ramp up national HIV responses and are jeopardizing broader outcomes for health, social development and economic growth.

UNAIDS estimates that globally, low and middle-income countries will need investments of US$ 29 billion annually to meet targets of ending AIDS as a public health threat by 2030. In 2021, only US$ 21.4 billion was spent on HIV responses low and middle-income countries. 

In order to advance urgent and collaborative action to keep HIV high on political agendas and re-prioritize funding for health and HIV, African ministers of finance joined international partners on the sidelines of the World Bank / International Monetary Fund Spring meetings in Washington DC to explore ways to ensure financial sustainability of domestic HIV responses.

During the event, Ministers of Finance and senior representatives from Angola, Burundi, Democratic Republic of the Congo, Eswatini, Kenya, Lesotho, Nigeria, Mozambique, Rwanda, South Sudan, Tanzania and Uganda, and the Minister of Health of Côte d’Ivoire came together with global partners, including PEPFAR, the US Department of the Treasury, UNAIDS and the Global Fund to Fight AIDS, TB and Malaria.

Participants explored co-creating country-led paths towards the sustainability of the HIV response within broader health financing challenges. In the dialogue with Ministers of Finance, several issues were explored, among those, the need to overcome financing bottlenecks for HIV, expand local production of medicines and health technologies, or strengthen health systems and pandemics preparedness, while considering the relevance of developing joint HIV financial sustainability road-maps. 

The event, ‘Investing in Sustainable HIV Responses for Broader Health Security and Economic Resilience in Africa’, was moderated by Donald Kaberuka, Chair of the Board of the Global Fund to Fight AIDS, Tuberculosis, and Malaria and the African Union’s High Representative for Financing, the Peace Fund and COVID-19 response. The event included remarks by;

• Alexia Latortue, Assistant Secretary for International Trade and Development, US Department of the Treasury,
• Dr. John N. Nkengasong, US Global AIDS Coordinator and Special Representative for Global Health Diplomacy, PEPFAR, US Department of State,
• Winnie Byanyima, Executive Director, UNAIDS, and  
• Symerre Grey Johnson, Head of Regional Integration Infrastructure and Trade, New Partnership for Africa's Development (AU/NEPAD)

Participants also reflected on the finding of the recently released report by the Economist Impact, supported by UNAIDS, titled A Triple Dividend: The health, social and economic gains from financing the HIV response in Africa. The report provided evidence showing that fully financing the HIV response to get back on track to achieve the 2030 goals will produce substantial health, social and economic gains in 13 countries in sub-Saharan Africa. 

This meeting was the first in-person discussion among ministers of finance and international partners around the sustainability of the HIV response held since COVID-19 travel restrictions were lifted. The meeting will be followed by a series of regional and in-country engagements to advance the financial, political and programmatic sustainability of the HIV response in preparation for the African Union’s Assembly of Heads of State Extraordinary Session on Ending AIDS by 2030.

NEW YORK/GENEVA, 28 September 2022—During the high-level week of the 77th session of the United Nations General Assembly leading African Ministers of Health joined UNAIDS, PEPFAR, global health institutions and partners in New York in rallying to sustain their commitments to end AIDS and accelerate their response to current and future pandemics. The high-level side event on “Political Leadership in the HIV Response”, highlighted continued progress on combating HIV in sub-Saharan Africa, which has been largely sustained despite the added challenges of the COVID-19 pandemic. 

Ambassador Dr. John Nkengasong, United States Global AIDS Coordinator and Special Representative for Health Diplomacy, who was celebrating his 100th day in office said, “The HIV response has defined global health for 25 years. We have made remarkable progress, but we still have remarkable challenges going forward to end AIDS. It is time to ask where we go from here. PEPFAR, the Global Fund and UNAIDS represent the best of humanity when we apply our minds to solving problems.”  

Ambassador Nkengasong also took the opportunity to launch “Reimagining PEPFAR's Strategic Direction, Fulfilling America’s Promise to End the HIV/AIDS Pandemic by 2030”, which focuses on key priority areas including: health equity for priority populations including children, adolescent girls and young women, and key populations; long term sustainability; positioning platforms to not civil society front and centre; and leading with science.  

“Our work continues with renewed urgency to accelerate our push to end AIDS by 2030,” said Winnie Byanyima, Executive Director of UNAIDS. “The actions needed to end AIDS are also key for overcoming other pandemics and for protecting ourselves against future threats. We can end AIDS by 2030. But the curve will not bend itself—we have to pull it down together.”    

African governments were represented by Ministers of Health from Botswana, Côte d’Ivoire, the Democratic Republic of the Congo, Eswatini, Malawi, Rwanda and South Africa, and the Director of Public Health from Nigeria, speaking on behalf of H.E. President Buhari, and were joined by H.E. Neo Jane Masisi, the First Lady of Botswana. 

The Minister of Health of Democratic Republic of the Congo, Jean-Jacques Mbungani, said, “Despite our many challenges, the Government made the fight against HIV a national priority. In one year, we increased our domestic funding for HIV from CDF10 billion to CDF15 billion, and from 2002 to 2020, we decreased AIDS-related mortality by 42%.” 

The Minister of Health of Côte d’Ivoire, Mr Pierre Dimba highlighted the importance of integrating lessons from COVID-19 in the HIV response. “The COVID-19 pandemic showed how important it is to invest in health and enhance our focus on HIV,” said Minister Dimba. “We have reinforced our health systems and are reinforcing our network of community health workers to reach people most in need as well as working closely with the education sector.” 

Rwanda has been investing in institutional reforms in the health sector and continues to increase its own domestic health funding. “For an effective management of domestic resources we created the Rwanda biomedical center which has a multifaceted approach,” said Daniel Ngamije, Minister of Health of Rwanda. “Rather than having individual programs for HIV, TB and malaria, we have created and financed a sustainable, integrated system.”  

Senator Lizzie Nkosi, Minister of Health of Eswatini, expressed appreciation of the partnership with donors and technical partners as key to the country’s success in the HIV response.  

Minister Nkosi used the event to announce impressive new results in Eswatini’s efforts to end AIDS. “Today I announce that Eswatini has reached the epidemic control and the 95-95-95 targets,” said Minister Nkosi. “We have committed significant resources for HIV, which we will continue, in spite of COVID-19 and other pandemics. However, we couldn’t have reached this success without PEPFAR, UNAIDS and the Global Fund and so many other partners.” 

The Minister of Health of Botswana highlighted the remarkable results Botswana has achieved and recognized the strong continued support of partners in Botswana’s progress to end AIDS. “Partners have contributed a lot to our achievements. In the early days our population was about to be wiped out by HIV, but last year we celebrated surpassing the 95-95-95 targets – that would not have been possible without sustained political leadership at the highest levels and the long-term partnerships we have,” said Minister Dikoloti.  

From South Africa, the country with the world’s largest HIV epidemic, Minister of Health Joe Phaahla called for accelerated momentum to end AIDS, and the urgency of halting HIV incidence, particularly in young people in South Africa. “We have reduced the incidence of HIV by over 45%, we now have 5.2 million people on HIV treatment, and we launched our HIV strategy with a focus on young people,” said Minister Phaahla. “Going forward, our focus will be on integrating programs—lessons which we have learned through COVID and HIV. When you’re under pressure to save lives, our key is integration—political leadership to mobilize leaders in all sectors, health workers and community health workers–bringing them onboard, and to maintain the momentum.”  

Reading a statement from H.E President Buhari of Nigeria, Dr Morenike Alex-Okah, Director of Public Health for Nigeria highlighted the call to end paediatric AIDS, “I reiterate the Government of Nigeria’s full commitment to the Sustainable Development Goals and other international and regional initiatives towards ending AIDS by 2030, and to addressing current and future health emergencies. As a demonstration of commitment, my government will convene African leaders and our international partners in Abuja in November 2022 to launch the Global Alliance to end paediatric AIDS by 2025.” 

Loyce Maturu from the Global Fund Advocates Network in Zimbabwe spoke about gaps in the HIV response. “We know that we haven’t done enough in the management of HIV in children, and to prevent HIV among adolescent girls and young women. We have to look at psychosocial support, mental health, and viral load monitoring, which have been missing when it comes to community engagement. We need to focus on HIV management at the community level, empower community-led monitoring, support families and strengthen community systems.”  

Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria expressed his appreciation for the support to the Global Fund at its 7th Replenishment which mobilized US$ 14.2 billion, “This is a great opportunity to say thank you to everyone who pledged contributions to the Global Fund, and particularly the implementing countries which have stepped up enormously,” said Mr Sands. “One of the great strengths of the HIV response was its relentless focus on outcomes, saving lives and reducing infections. One of the things we learned with COVID is that we have got to get smart at making investments that can serve multiple needs at once. A broader approach for health systems that can fight multiple diseases and cope with future threats.”  

Dr Matshidiso Moeti, the World Health Organization’s Regional Director for Africa, highlighted the need for governments to pick up the pace to end AIDS in Africa. “This is a fantastic convening of leaders who will play a key role in ending AIDS in Africa,” said Dr Moeti. “With HIV, we have learned many lessons. Inequities continue to be a major factor in driving vulnerability to HIV and access to services. We can make the resources go further and achieve more results for HIV.”  

Stéphanie Seydoux, France's Ambassador for Global Health concluded, “The time for implementation starts now. We know the way forward and that is country ownership, country investment.”  

The event, “Political Leadership in the HIV Response”, was co-organized by UNAIDS and PEPFAR on the margins of high-level week of the 77th Session of the United Nations General Assembly in New York. The video of the event is available at: UNAIDS/PEPFAR High-Level Side Event.  

PEPFAR 

PEPFAR is the largest commitment by any nation to address a single disease in history. Managed and overseen by the U.S. Department of State, and supported through the compassion and generosity of the American people, PEPFAR has saved 20 million lives, prevented millions of infections, and helped transform the global AIDS response. The U.S. President's Emergency Plan for AIDS Relief - United States Department of State  

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.

MONTREAL, CANADA 29 July 2022—The Joint United Nations Programme on HIV/AIDS (UNAIDS) welcomes the latest data released by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), which demonstrate the life-saving impact of PEPFAR funding and programmes on countries and communities. UNAIDS also applauds the continued, strong bipartisan leadership of the United States in the global response to HIV.

“PEPFAR’s latest impressive results show the outstanding impact and unique contributions of the United States to meeting the 2025 global HIV targets,” said Winnie Byanyima, UNAIDS Executive Director. "At a moment when some other bilateral donors retreated from their global commitments, the United States Administration and Congress continued to give strong, and critical support to PEPFAR, enabling countries to transition from epidemic control towards ending their AIDS epidemics,” said Ms Byanyima. “Together we are rallying other donors to follow the United States’s example.”

PEPFAR announced the new data on the opening day of the 24^th International AIDS Conference, presenting the life-saving impact of PEPFAR investments and programmatic support to partner countries.

Ambassador John Nkengasong, United States Global AIDS Coordinator and Special Representative for Health Diplomacy said, “Comprehensive HIV prevention and treatment programmes have always been a priority for PEPFAR. Through the reduction of incidence and prevalence of HIV among adolescent girls and young women, women of childbearing age, and adult men, an additional 3.5 million babies were born HIV free between 2004 to 2021 and a total of 5.5 million babies have been born HIV-free as a result of PEPFAR and its partners.”

PEPFAR’s statement can be read at https://www.state.gov/pepfar-shows-impact-with-5-5-million-babies-born-hiv-free-due-to-comprehensive-program-efforts/

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.

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.

GENEVA, 06 May 2022—UNAIDS warmly congratulates John Nkengasong on confirmation by the U.S. Senate as Ambassador-at-Large and Coordinator of United States Government Activities to Combat HIV/AIDS Globally. As the new U.S. Global AIDS Coordinator, Dr Nkengasong will lead the United States’ President’s Emergency Plan for AIDS Relief (PEPFAR).

“This is great news for the world. John Nkengasong is an inspired choice to lead PEPFAR,” said Winnie Byanyima, Executive Director of UNAIDS. “He is one of the world’s leading experts on HIV and pandemic preparedness and has practical experience on how to advance efforts to end AIDS amidst the COVID pandemic. We need the kind of bold thinking and commitment that he has brought throughout his career. It will be a true honour to work with him in his new role, supporting continued United States leadership on HIV, and strengthening the life-saving partnership between the UNAIDS Joint Programme and PEPFAR.”

An HIV virologist with more than three decades of experience in the global HIV response, Dr Nkengasong’s work on COVID-19 in his most recent highly acclaimed role as the founding director of the Africa Centres for Disease Control and Prevention has been internationally recognized.

PEPFAR is a critical partner of UNAIDS, with an unprecedented proven track record of global life-saving work. In over 80 countries, PEPFAR and UNAIDS work hand-in-hand providing support to governments and communities to implement the Global AIDS Strategy and accelerate ending AIDS. Together they ensure that efforts are focused on the people and areas most affected by HIV, including supporting children, women and girls, and key populations.

Since its inception in 2003, the US Government, with bipartisan support, has invested over US$100 billion through PEPFAR – the largest commitment by any nation to address a single disease. The United States’ investments and efforts have saved more than 21 million lives, prevented millions of HIV infections, and accelerated progress toward ending AIDS in over 50 countries.

The world is currently confronted with dual global pandemics. As Dr Nkengasong has noted, “We have seen how COVID-19 has affected some progress in our HIV efforts with devastating results, but we have also witnessed how the health systems and institutions built and strengthened by PEPFAR’s investments have been central to the COVID-19 response.” Through bold global action, the end of AIDS is possible, and actions to accelerate ending AIDS will strengthen the world’s efforts to beat all pandemics.

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.

UNAIDS, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) came together this week to co-host an event on the powerful partnership between the three organizations, countries and communities. The event, held on the sidelines of the 76th session of the United Nations General Assembly, highlighted the millions of lives saved through the partnership but warned that COVID-19 has hit hard and risks derailing efforts to end AIDS by 2030.

“We are in one of the most challenging moments in the history of HIV and global health,” said Winnie Byanyima, the Executive Director of UNAIDS. “We must act urgently. Our partnerships are strong and flexible and we must use what we have learned together to prevent a resurgent AIDS pandemic, to end inequalities and to tackle COVID-19.”

COVID-19 has had a hugely damaging impact on HIV services over the past 18 months. Peter Sands, the Executive Director of the Global Fund, said that the number of mothers receiving prevention of mother-to-child transmission of HIV services dropped by 4.5%, the number of people reached with HIV prevention programmes declined by 11%, HIV testing declined by 22% and voluntary medical male circumcision for HIV prevention dropped by 27%. “We were off track against our targets before COVID-19 hit and COVID-19 has knocked us further off track,” he said. “It’s going to be incredibly difficult to get fully back on track on HIV until we have got on top of COVID-19.” 

Widening inequalities due to COVID-19 were highlighted by the First Lady of Namibia, Monica Geingos, who joined Ms Byanyima in a live discussion from New York, United States of America. “After lockdown we are seeing a doubling of adolescent pregnancy rates, and we are assuming that new HIV infections among 15–24-year-olds will also increase,” she said. “When you remove children from a school environment, when you remove sex education you compromise education outcomes.” UNAIDS data show that if girls complete secondary education, it can reduce their risk of HIV infection by up to half in some countries.

Felix-Antoine Tshisekedi Tshilombo, the President of the Democratic Republic of the Congo and Chair of the African Union, joined the event with a powerful video message, saying, “We have been fighting HIV for 40 years and our successes and failures have taught us that we cannot conquer a pandemic without ending inequalities, promoting people-centred approaches while respecting human rights.”

The need for strong and continued partnerships to tackle both HIV and COVID-19 was strongly emphasized. Angeli Achrekar, the Acting United States Global AIDS Coordinator, who joined the event live in New York, said, “Nothing is possible without partnership. The partnership we have with PEPFAR, the Global Fund and UNAIDS is absolutely essential because we work hand in hand with countries and communities, the private sector and multilateral organizations to make things happen.”

The speakers urged bold political leadership, global solidarity and strategic partnerships that engage the people most affected by HIV. “What we need from governments is that they know that without us they cannot reach communities and achieve the ambitious goals,” said Sbongile Nkosi, the Co-Executive Director of the Global Network of People Living with HIV, who joined live from South Africa. “Governments must understand that we are the best allies in the response. We know the struggle, we know the solutions and we are committed to ending AIDS.”

The event was held at a landmark moment, 40 years since the first AIDS cases were reported and at the 25th anniversary of UNAIDS and the 20th anniversary of the Global Fund. “Forty years ago, a new virus emerged and sparked the HIV/AIDS pandemic,” said Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organization. “Life-saving medicines were developed but the world’s poorest had no access to them and addressing this dire crisis of inequity took more than a decade. The multisectoral efforts often led by communities of people living with or affected by HIV were supported by unprecedented levels of international assistance from UNAIDS, the Global Fund and PEPFAR. Since then, millions of lives have been saved.”

There have been major successes in stopping new HIV infections among children and reducing AIDS-related deaths, but despite a 59% decline in AIDS-related deaths among children between 2010 and 2020, Omar Abdi, the Deputy Executive Director of the United Nations Children’s Fund, stressed that much more needs to be done. Just 54% of children living with HIV were accessing HIV treatment in 2020, compared to 74% of adults. “Ending AIDS in children needs our collective action to link the 1.7 million children living with HIV globally to HIV treatment to keep them healthy and alive. That’s why we are proposing a global framework to drive commitment and catalyse global action to end paediatric AIDS,” he said.

Usha Rao-Monari, the Associate Administrator of the United Nations Development Programme, highlighted the inequalities preventing key populations from accessing HIV services. She said that HIV services for key populations are “uneven or entirely absent” and underscored that key populations and their sexual partners account for 65% of new HIV infections worldwide, and for 93% of infections outside of sub-Saharan Africa. “Our work is absolutely not done,” she said. “Gender and other intersecting inequalities as well as punitive and discriminatory laws make people more vulnerable to HIV and hinder access to services. We need to address the inequalities that for decades have fuelled the spread of HIV.”

The hybrid event was a mixture of in-person discussions from the live venue in New York, video messages and live video link-ups from around the world. It was moderated from Nairobi, Kenya, by award-winning journalist Victoria Rubadiri, with live moderation of in-person discussions in New York by Regan Hofmann, Director, a.i., of the UNAIDS Liaison Office in Washington, DC, United States.