“PEPFAR means the American people care about us.’ That wonderful phrase captured the sentiments I have heard from nearly every corner of Africa – one that has grown…as individuals, families, communities, and nations moved from total despair to hope for the future. Hope… awakens a lost desire to find a job, go to school, feed a family, care for your community. It is, in fact, the basis for economic growth and the development of markets for U.S. goods and services.”

– The Honorable, Mark Dybul, MD, an architect of the PEPFAR program.

What is the President’s Emergency Plan for AIDS Relief (PEPFAR)?

The President’s Emergency Plan for AIDS Relief is a ground-breaking program created by President George W. Bush and the U.S. Congress twenty years ago. It was — and remains — the largest-ever commitment by any nation to combat a single disease and it came in response to the devastating impact of HIV on sub-Saharan Africa. As recently as the early 2000s, two million people were dying every year from AIDS-related complications because they did not have access to treatment that had been widely available in rich countries for a decade and a half. U.S. lawmakers authorized PEPFAR through the U.S. Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003, and have reauthorized the program every five years since then. Congress must once again reauthorize PEPFAR in 2023 and First Focus on Children urges lawmakers to enact a “clean” reauthorization and to retain the program’s 10% set aside for Orphans and Vulnerable Children (OVC).

What has PEPFAR accomplished?

Since its inception, PEPFAR has transformed the global health landscape. In partnership with the Global Fund to Fight AIDS, TB and Malaria, PEPFAR has saved more than 25 million

lives, helped partner countries control their HIV epidemics and surpass the UNAIDS 95-95-95 goals. Beyond HIV, PEPFAR has built and strengthened global health systems by supporting 70,000 facility and community health clinics and 3,000 labs, and training 340,000 health care workers. Further, the program has helped more than 50 countries strengthen their pandemic preparedness and response efforts. Thanks to the U.S. and its partners, global AIDS-related deaths have plummeted by 64% since 2004 and new infections have declined by 52%. PEPFAR and its partners have placed the world on the path to achieving the global target of ending HIV and AIDS by 2030.

Why is the 10% set aside for Orphans and Vulnerable Children (OVC) important, especially now?

In 2003, a bipartisan group of House and Senate lawmakers came together to ensure the protection and care of children hardest hit by the HIV pandemic. Senators Durbin (D-IL), former Senator Lugar (R-IN), Representatives Barbara Lee (D-CA), Betty McCollum (D-MN), former Representatives Tom Lantos (D-CA) and Henry Hyde (R-IL) offered an amendment to set aside 10% of overall PEPFAR funding for orphans and vulnerable children (OVC). The wrap-around programs funded by the set aside proved prescient in solving the complicated puzzle of HIV’s negative impact on kids and is needed now more than ever. While AIDS is no longer a death sentence on the African continent, the number of orphans has grown, from 12.4 million when PEPFAR was created to 13.9 million in 2021. In addition, millions more vulnerable children, whose numbers have always been next to impossible to count, also remain just as disadvantaged. (PEPFAR’s revolutionary OVC programs have been so successful that they have recently been offered up as a model for addressing the needs of the 10.5 million children who have lost a primary or secondary caregiver to COVID-19.) The 10 percent set aside for OVC ensures the health, nutrition, and wellbeing of millions of children affected by HIV and Congress must protect it in the 2023 Reauthorization of PEPFAR.

How does PEPFAR support the most vulnerable children?

PEPFAR provides anti-retroviral treatment to pregnant women to ensure that babies with HIV-infected mothers are born HIV-free. The program also provides pediatric HIV treatment to children who are infected. Without treatment, 50% of HIV-positive children will die before their second birthday and 80% will die by age five. Thanks to PEPFAR, 5.5 million babies have been born HIV-free and 52% of HIV-positive children now have access to pediatric HIV treatment.

In addition, PEPFAR invests 10% of its funding in the care and support of orphans and vulnerable children, which protects and mitigates the impact of HIV on these children. The burden of HIV negatively impacts all aspects of a child’s life — their mental and physical health, their nutritional status, their educational achievements, and their risk for future HIV infection. The threat and burden of HIV puts a tremendous strain on all aspects of socioeconomic and health outcomes in an affected community.

PEPFAR is currently supporting 7.2 million orphans and vulnerable children and their caregivers with interventions that ensure affected children enjoy good nutrition, access to school, and psychosocial support to address stigma and that their caregivers have access to savings and livelihood support. These holistic services keep children’s families together and functioning, and connect them to HIV treatment services if they are HIV positive (thereby also contributing to the achievement of global treatment goals).

Unfortunately, children continue to be left behind in the global HIV response. Just slightly more than half of all children living with HIV are on life-saving treatment, versus roughly 70% of adults. The 10% set aside for OVC allows community health workers and case managers to help vulnerable families navigate the stigma, poverty, violence, and social and legal systems that may otherwise pose insurmountable hurdles to accessing and remaining on treatment. PEPFAR’s OVC programs play a key role in finding HIV-positive children, getting them tested, and accompanying them to ensure adherence to treatment regimens.

First Focus on Children urges lawmakers to enact a “clean” reauthorization of PEPFAR and to retain the program’s 10% set aside for Orphans and Vulnerable Children.

For more information please contact Leila Nimatallah, VP of Advocacy and Mobilization, Leilan@FirstFocus.org and Kathy Sacco, VP of International Children’s Policy, Kathys@FirstFocus.org.