International AIDS relief program, at 20, looks to next steps

BANGKOK — Saturday marks a major milestone in the global fight to eliminate the AIDS epidemic, as the U.S. President’s Emergency Plan for AIDS Relief celebrates its 20th anniversary as the largest commitment by a country to combat a disease.

PEPFAR, launched under then-President George W. Bush, has now spanned four administrations, operates in more than 50 countries, and has helped increase access to HIV prevention tools and treatment.

It’s also reduced transmission and progression of the disease and, with the help of new pre-exposure prophylaxis and antiretroviral drugs, reduced deaths globally. Since its inception, the U.S. government has invested more than $100 billion, with the program estimated to have saved 20 million lives globally.

And it’s moving the world toward a larger goal: In 2016, United Nations member states, including the U.S., committed to ending the AIDS epidemic by 2030.

Parts of the PEPFAR program are up for reauthorization this year, giving policymakers a new opportunity to examine how to achieve international goals amid competing global health priorities, local policy changes and stigma against at-risk populations. The program has historically seen strong bipartisan support.

In the U.S., the Ryan White Program, housed under the Health Resources and Services Administration, administers HIV programming primarily through state and local grants. It’s often touted as the gold standard for domestic health programming.

But the models used successfully in the U.S. may not translate to other countries, and experts acknowledge that there is room to improve the response.

“HIV remains a serious threat to global health security and economic development,” wrote Secretary of State Antony Blinken in December as part of a report updating the agency’s five-year strategy. “Our progress can be easily derailed if we lose our focus or conviction, or fail to address the inequities, many fueled by stigma and discrimination and punitive laws, that stand in our way,”

The report highlights five main challenges ahead: continuing to identify and treat HIV-positive individuals in the face of changing demographics and populations affected, reducing new HIV infections globally, reducing transmission inequities in PEPFAR-supported nations, improving public health infrastructure and local government partnerships, and combating the effects of other infectious health threats that could thwart progress.

On a Saturday morning in November, the staff at a Bangkok HIV clinic set up for their afternoon stream of patients. Rainbow Sky Association of Thailand, RSAT, is a Thai community group that conducts outreach for populations at-risk for HIV — primarily serving gay men and transgender women.

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