A major player in the fight against HIV/AIDS, Pepfar celebrates its 20th anniversary

US Secretary of State Antony Blinken speaks about Pepfar on World AIDS Day on December 2, 2022. AP - Jonathan Ernst

Text by: Simon Rozé Follow

4 mins

The Presidential Plan for the fight against AIDS was launched in 2003 by US President George W. Bush with the aim of supporting countries, particularly in Africa, in their fight against the epidemic.

Two decades later, the program can boast many successes, but has also garnered some criticism.


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 Rarely has history offered an opportunity to do so much, for so many. 

On January 28, 2003, George W. Bush addresses the US Congress for the annual State of the Union address.

Between two salvos of criticism against the Iraqi regime of Saddam Hussein, he announced the launch of the presidential plan for the fight against AIDS: Pepfar.

Fifteen billion dollars mobilized in five years to combat the HIV/AIDS epidemic on the African continent.

At the time, the information passed almost unnoticed, a few months before the outbreak of the war in Iraq.

However, 20 years later, Pepfar has become an indispensable tool in the fight against the epidemic.

The figures put forward by the organization measure the extent of the progress made.

Since 2003, more than 100 billion dollars have been mobilized and have saved 25 million lives.

At the same time, this funding has contributed to the training of 340,000 health workers.


 Pepfar is one of the biggest, if not the biggest donor in the fight against HIV/AIDS 

", abounds Pape Deme, head of advocacy for the Coalition Plus, which brings together international NGOs from fight against the epidemic.


 Each year, Pepfar mobilizes its resources on the countries where they have the most impact, in particular in the regions of West and Central Africa, and in East Africa.

There is, however, a disparity, with the latter benefiting from much more advanced technologies and policies than the West African region lagging behind in terms of funding.


The ABC strategy criticized

The use of Pepfar funds in its history has indeed not been without criticism.

The massive amount of money made available has, for example, been able to destabilize local health systems by increasing pay disparities between NGO health workers who could earn up to twice as much as their public sector colleagues.


 There is indeed this observation that there is a need for a new approach to Pepfar's programs to fill these disparities 

", adds Pape Deme.

 It is a fact that destabilizes the systems. 


Pepfar was also widely criticized in its early years for its approach to prevention, which was then based on what is called the "ABC strategy" for " 

Abstinence, Be faithful, use a Condom 



which can be translated as " Abstinence, being faithful, using a condom”.

This strategy, for example, recommends the use of condoms only to high-risk groups and not to the general population.

Put forward by the American conservative religious right,

this approach reserved for the African continent has been much criticized.

, because it has had limited effectiveness in changing behavior, delayed the dissemination of risk prevention information, and undermined prevention programs for African youth.

This ABC strategy was nevertheless abandoned in 2008, in favor of scientifically validated programs, although it still survives at the margin in a few projects.


 We must recognize this desire to change and to go directly to the needs and the different contexts 

", adds Pape Deme.

 All the same, there are still efforts to be made, because it remains an American system which is based on traditionalist foundations.

But we remain hopeful that these changes will continue and adapt to the context of the communities. 


Ending the epidemic in 2030

Marker of these recent developments, the appointment of Dr. John Nkengasong as head of Pepfar in the summer of 2022 has been well received by civil society.

Born in Douala, this American-Cameroonian, virologist, previously headed the African Centers for Disease Control and Prevention.

 It gives an image of Pepfar that is much closer to the needs and realities of African countries.

This is an important and very positive sign 

”, approves Pape Deme.

At the head of Pepfar, John Nkengasong will have a heavy task reaffirmed by

the administration of Joe Biden last December

 : to end the HIV/AIDS epidemic by 2030. The work to be done is however colossal, as

Winnie Byanyima reminded us .

on RFI on December 1,

World AIDS Day.

The head of UNAIDS believed that the recent crises of Covid-19, energy and the war in Ukraine compromised an already badly started fight: “

 All of this is leading us in the wrong direction.

Let me say, however, that we were not moving fast enough even before these crises.

So we just have to pull ourselves together and double down. 


She concluded: “

 We are not going in the right direction.

AIDS is still there: 650,000 people died of it last year.

One every minute.

We must remember that it continues and that it will get worse if we relax our efforts.

We must continue the fight. 



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