Evaluating Outcomes of the President’s Emergency Plan for AIDS Relief in Africa

TO THE EDITOR

I applaud Bendavid and Bhattacharya (1) for undertaking a much-needed quantitative evaluation of the effectiveness of the President’s Emergency Plan for AIDS Relief (PEPFAR), the largest international health initiative dedicated to a single disease.

Although it is important to recognize PEPFAR’s success in decreasing AIDS-related deaths by more than 10% and in providing antiretroviral therapy to more than 2 million people (2), it is no less important for the authors to conclude that PEPFAR has had no success in lowering HIV prevalence in adults. In 2007, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that there were 2.7 million new HIV infections, which is 5 new infections for every 2 persons receiving treatment (3).

As a woman living with HIV in one the hardest-hit countries, Botswana, I urge the world to recognize that a meaningful, sustainable response to the pandemic must focus on HIV prevention and on women, particularly young women. Most persons living with HIV/AIDS live in sub-Saharan Africa (22 million of the 33.2 million worldwide) and are adults, of which 61% are women (3). In my region, 3 young women aged 15 to 24 years are infected for every young man in the same age range (4).

To be most effective, PEPFAR-supported prevention programs must ensure that all persons have access to the full range of information and services to protect themselves from HIV throughout their lives, including female and male condoms. PEPFAR’s effectiveness also requires integration of family planning and other HIV services; widespread access to comprehensive sexual education; and the protection of all persons’ human rights to live free of stigma, discrimination, and violence. Recipients of PEPFAR funding must be free to work with all communities at risk for HIV, including sex workers.

It is our moral obligation and fiscal responsibility to use PEPFAR funding to prevent as many infections as possible. Large sums of money spent unwisely will not save lives and will create an ever-growing need for increased resources in the future.