THE year 2023, January 28 to be precise, marked exactly 20 years since American President George W. Bush announced the creation of the U.S. President’s Emergency Plan for AIDS Relief (#PEPFAR) during his State of the Union address. The new initiative included the goal of providing HIV treatment to two million people living with HIV over five years with a budget of USD$15 billion dollars. This was the birth of PEPFAR, now the largest commitment by any nation to address a single disease.
The new initiative included the goal of providing HIV treatment to two million people living with HIV over five years with a budget of USD$15 billion dollars. This was the birth of PEPFAR, now the largest commitment by any nation to address a single disease.
Michael Gwarisa, The HealthTimes Editor took time to interview Carey Speaks, the PEPFAR Country Coordinator in who spoke at length on PEPFAR’S work in Zimbabwe over the past 20 years.
MICHAEL: What does PEPFAR reaching 20 years of existence mean for the organization and the American Government?
CAREY SPEAKS: The United States Government (USG) is tremendously proud of the milestones achieved over the past two decades. PEPFAR has helped save more than 25 million lives across the globe. Before the advent of PEPFAR, AIDS was truly a death sentence – it created millions of orphans and stalled economic development. Today, a disease that seemed unstoppable is in retreat.
Though initially established as an emergency fund, PEPFAR has transitioned from an emergency response to one that supports country ownership in national responses to HIV/AIDS. PEPFAR is committed to working with partner governments, private and public organizations, faith-based communities, multi-lateral organizations, and others to end HIV/AIDS as a public health threat by 2030.
Globally, since the start of PEPFAR, new HIV infections have been reduced by 42% since the peak in 2004, and AIDS-related deaths have declined by 64% since their peak in 2004 – thanks in large part to PEPFAR and U.S. contributions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
The American people, through the PEPFAR, are proud to be working in partnership with the people of Zimbabwe in the fight against HIV/AIDS.
MICHAEL: Of these 20 years, PEPFAR has been implementing HIV programs in Zimbabwe for the past 17 years. Can you tell us how your journey has been like in Zimbabwe?
CAREY SPEAKS: While President Bush was announcing PEPFAR’s creation, HIV was devastating Zimbabwe. Few people had access to treatment and more than 330 people were dying every day from AIDS-related illnesses. Today, that has changed thanks to the massive scale of treatment and support from the United States and other donors. Of the 1.3 million Zimbabweans living with HIV, over 1.2 million Zimbabweans are now receiving life-saving HIV treatment, and 93 in every 100 (93 %) have achieved viral load suppression, meaning reduced HIV transmission, and reduced progression to AIDS – a major milestone in bringing the infection under control. Mortality is a fraction of what it was before PEPFAR’s creation.
PEPFAR has played a unique role, bringing scientific know-how and on-the-ground expertise in the national response to HIV and AIDS in collaboration with the Ministry of Health and Child Care (MoHCC). While no PEPFAR assistance goes directly to the Government of Zimbabwe, it does support thousands of health care workers through implementing partners and non-government organizations who carry out the work. PEPFAR supports these health care workers, as well as key staff in district and regional health offices and laboratories, with salary supplements, stipends, travel expenses, and other forms of support.
PEPFAR has played a critical role in building partner nations’ health architecture over the past two decades, training medical personnel, creating prevention programs, providing broad-use diagnostic equipment and personal protective equipment (PPE), and establishing systems to trace infections.
Partnerships play a big role in PEPFAR, as U.S. Global AIDS Coordinator and Special Representative for Health Diplomacy Ambassador Dr. John Nkengasong, who oversees PEPFAR says, “Nothing can be achieved without partnerships – it is one of the key drivers of the remarkable impact the PEPFAR program has had over the past 20 years and partnerships are critical to the program’s future success.”
Through strong collaboration with the MoHCC, the Global Fund, and other partners, we expect not only to control the HIV epidemic, but also to reduce the future costs required to sustain the HIV and AIDS response.
MICHAEL: What positive changes did you witness in Zimbabwe’s HIV sector as a result of PEPFAR’s intervention and what have been some of your major achievements in Zimbabwe with regards to offering comprehensive HIV programing?
CAREY SPEAKS: The changes are voluminous and the impact of PEPFAR on the Zimbabwean communities is profound. We have the data and evidence to support this impact. Many people living with HIV are now able to access health services and enjoy quality life. For instance, PEPFAR supports the improvement of laboratory capacity nationwide. This enables quick specimen transport and results utilization and ultimately increases access to health services including viral load (VL) monitoring, which is key to accelerating Zimbabwe to reach epidemic control.
We are excited that millions of lives have been saved thanks to PEPFAR, including 1.28 million Zimbabweans currently receiving HIV treatment. In Zimbabwe, the U.S. government has provided:
- HIV testing and counseling for nearly 1.28 million people;
- Cervical cancer screening for more than 192,400 HIV-positive women;
- Viral load testing for more than 800,000 people living with HIV;
- Voluntary medical male circumcision for 134,794 men to reduce the risk of contracting and transmitting HIV;
- Tuberculosis (TB) preventive treatment for more than 653,400 people; and
- Services for 423,574 orphans and vulnerable children and their families, including HIV prevention, care,and treatment, education support, psychosocial services, and/or economic strengthening.
Since 2015, PEPFAR has supported HIV prevention services to more than one million at-risk adolescent girls and young women (AGYW) between the ages of 10 to 24 through the DREAMS program in Zimbabwe. DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) support includes HIV prevention packages, pre-exposure prophylaxis to help prevent them from contracting HIV, economic strengthening initiatives, educational subsidies, and complementary services for orphans and vulnerable children. Young girls have become economically empowered and some are engaged in beneficial income generating projects.
PEPFAR has a history of providing essential support, including laboratory and surveillance strengthening and human resources, to Zimbabwe’s health system. Such programs became the foundation of the COVID-19 response, and technical assistance from PEPFAR has shifted to support key roles in helping the country formulate sound public health policies and procedures including the respond to the COVID-19 pandemic and other emergencies.
The end of HIV/AIDS as a public health threat by 2030 is an ambitious but achievable goal. As President Biden declared on World AIDS Day 2022, “We finally have the scientific understanding, treatments, and tools to build an AIDS-free future where everyone – no matter who they are, where they come from, or whom they love – can get the care and respect they deserve.”
MICHAEL: How much in financial support have you extended to Zimbabwe’s HIV response from the time you started offering services to date?
CAREY SPEAKS: Today, as we mark twenty years of PEPFAR, we are excited that the U.S. government has invested more than USD$2 billion towards Zimbabwe’s HIV/AIDS response. During the last fiscal year alone, PEPFAR invested $213,229,251 in Zimbabwe for HIV/AIDS programs, including $9.4 million for COVID-19 related activities.
MICHAEL: What would you say have been some of the challenges you encountered in your quest to offer services and how were they overcome?
CAREY SPEAKS: Despite the amazing progress, there are still more than 22,000 new HIV infections in Zimbabwe each year. The last mile of the response is the greatest challenge. We are working with our multisectoral partners to focus on areas where gaps still exist among key, vulnerable populations – including men who have sex with men, female sex workers, and transgender people – to end HIV/AIDS as a public health threat by 2030.
U.S. Embassy Charge d’Affaires Elaine French recently sat down with one of the PEPFAR Heroes, Ms. Gumisayi Bonzo, who recounted her time spent protecting women like herself who are living with HIV. Ms. Bonzo also works closely with transgender and intersex people in Zimbabwe and other key populations to ensure their human rights are protected. PEPFAR is proud to work with Heroes like Ms. Bonzo to support enabling environments and to erase barriers to quality HIV service access, such as stigma and discrimination, gender-based violence, harmful policies, and discriminatory legislation that further marginalizes individuals and threatens the human rights and dignity of all.
MICHAEL: With the growing donor fatigue in the world, are we likely to see PEPFAR reducing the amount of financial support to Zimbabwe’s HIV programs and how committed is PEPFAR to continue supporting Zimbabwe’s HIV programs?
CAREY SPEAKS: This year, the U.S. government approved $203.8 million for programs in Zimbabwe to strengthen health systems, expand local capacity to prevent new HIV infections, and reach sustained epidemic control. The approved plan will advance client-centered services and support thousands of Zimbabwe’s health care workers to continue carrying out their critical work. We will continue to invest in communities and work with individual leaders, including the PEPFAR Heroes, who have gone above and beyond the call of duty to give a voice to marginalized groups.
HIV/AIDS is a lifelong disease and sustaining HIV impact will be a multi-decade effort. UNAIDS has set global targets calling for 95% of all people living with HIV to know their HIV status, 95% of all people with diagnosed HIV infection to receive sustained antiretroviral therapy, and 95% of all people receiving antiretroviral therapy to have viral suppression by 2025. If the global community is successful in reaching the 95-95-95 goals along with near-universal HIV prevention and treatment coverage but does not actively plan for sustaining HIV impact, all the gains made over two decades of PEPFAR will be under threat.
Maintaining treatment continuity, reducing mortality, and improving quality of life are critical components of the sustained response. PEPFAR will be building sustainability efforts with countries in the lead to ensure a transparent process with shared expectations.