How is the United States’s international HIV prevention programme evolving?

  • Christine Evain
Keywords: President’s Emergency Plan For AIDS Relief (PEPFAR), AIDS Relief, United States, Foreign aid, HIV prevention, Uganda


The President’s Emergency Plan For AIDS Relief (PEPFAR) is a 1998 United States governmental initiative to prevent the spread of AIDS, primarily in Africa. The PEPFAR program has provided antiretroviral treatment to over 11 million HIV-infected people in Africa and it has been called the largest health initiative ever initiated by one country to address a disease, with a budget exceeding $70 billion since its creation.

While PEPFAR has been praised for having saved millions of lives, diminishing media attention to AIDS as well as potential policy changes are likely to negatively impact the progress of the organization in the future. Thus a number of questions arise: How has PEPFAR’s policy been driven and assessed so far? What are the key factors which have led to PEPFAR’s success? How does it measure its own efficiency? How does PEPFAR compare to other international organizations? What are its links with local organizations? How does it relate to its partners?  The aim of this paper is to consider these important questions and to map out the shifting balance of HIV prevention in the next decade.

This study is based on the institutional documentation, press articles as well as on a series of interviews conducted with local members of HIV/AIDS Disease Control and Prevention programmes in Africa.


Adekemi, Sekoni, Uthman Oluwaseun, and Somefun Esther. 2017. ‘P4.99 Hiv Status Does It Make a Difference? Sexual Behaviourof Hiv Positive Men Attending a Comprehensive Treatment Centre in Lagos, Nigeria’. Sex Transm Infect 93 (Suppl 2):A227–28.

Alcorn, Keith. 2015. ‘US PEPFAR Abstinence and Faithfulness Funding Had No Impact on Sexual Behaviour in Africa’. 26 February 2015.

Anderson, Jessica. 2017. ‘Trump Wants to Divert Aid Away from Women and the Environment’. Washington Post, 12 May 2017.

Barton-Knott, Sophie. 2016. ‘L’ONUSIDA et Le PEPFAR Annoncent Une Baisse Spectaculaire Des Nouvelles Infections À VIH Chez Les Enfants Dans Les 21 Pays Les plus Touchés Par Le VIH En Afrique | ONUSIDA’. 2016.

Bryson, Donna. 2009. ‘US AIDS Program Undaunted by Recession, Head Says’. Newsday. 18 November 2009.

Chidza, Richard. 2017. ‘US Promises More Funds for HIV, Aids’. NewsDay Zimbabwe (blog). 8 June 2017.

Chin, Roger J., Domrongphol Sangmanee, and Lisa Piergallini. 2015. ‘PEPFAR Funding and Reduction in HIV Infection Rates in 12 Focus Sub-Saharan African Countries: A Quantitative Analysis’. International Journal of MCH and AIDS 3 (2):150–58.

Cooper, Helene. 2017. ‘Trump Team’s Queries About Africa Point to Skepticism About Aid’. The New York Times, 13 January 2017, sec. Africa.

Crossan, Andrea. 2017. ‘Remembering AIDS Activist Prudence Mabele’. Public Radio International. Minneapolis.

Cuadros, Diego F., Jingjing Li, Adam J. Branscum, Adam Akullian, Peng Jia, Elizabeth N. Mziray, and Frank Tanser. 2017. ‘Mapping the Spatial Variability of HIV Infection in Sub-Saharan Africa: Effective Information for Localized HIV Prevention and Control’. Scientific Reports 7 (August).

Davis, Sara L. M. 2017. ‘The Uncounted: Politics of Data and Visibility in Global Health’. The International Journal of Human Rights 21 (8):1144–63.

Doshi, Monika, Lisa Avery, Ronnie P. Kaddu, Mary Gichuhi, Gloria Gakii, Elsabé du Plessis, Sumit Dutta, Shamshad Khan, Joshua Kimani, and Robert Lorway. 2017. ‘Contextualizing Willingness to Participate: Recommendations for Engagement, Recruitment & Enrolment of Kenyan MSM in Future HIV Prevention Trials’. BMC Public Health 17 (May).

Downie, Richard. 2017. ‘Advancing Country Partnerships on HIV/AIDS | Center for Strategic and International Studies’. Center for Strategic and International Studies, 9 August 2017.

Editorial Le Monde. 2005. ‘La conférence sur le sida en Afrique refuse de faire la promotion de l’abstinence’. Le, 9 December 2005.

Editorial La Dépêche. n.d. ‘Lutte Contre Le VIH/SIDA : En Finir Avec L’abstinence’. Accessed 11 September 2017.

Firger, Jessica. 2016. ‘13 Faces of AIDS Activism’. Esquire, 28 November 2016.

Fortin, Jacey. 2017. ‘How to Help Hurricane Irma Victims (and How to Avoid Scams)’. The New York Times, 8 September 2017, sec. U.S.

Frist, Bill. 2017. ‘Opinion | Bill Frist: The Case for Keeping America’s AIDS Relief Plan’. The New York Times, 9 February 2017, sec. Opinion.

Gqola, Pumla Dineo. 2015. Rape: A South African Nightmare.

Hagopian, Amy, Deepa Rao, Aaron Katz, Sallie Sanford, and Scott Barnhart. 2017. ‘Anti-Homosexual Legislation and HIV-Related Stigma in African Nations: What Has Been the Role of PEPFAR?’ Global Health Action 10 (1).

Harris, Gardiner. 2017. ‘Cuts to AIDS Treatment Programs Could Cost a Million Lives’. The New York Times, 23 May 2017, sec. Africa.

Huni, Shingirai. 2017. ‘Let Trump see the speck in his eye first’. The Herald Zimbabwe, 22 September 2017.

IAS 2017 Plenary Session - 24 July 2017 - YouTube. n.d. Accessed 20 September 2017.

Jordan, Sara R., and Jaimie Edwards. 2016. ‘Defining Agency and Vulnerability: PEPFAR and the Role of Women in HIV/AIDS Prevention’. World Medical & Health Policy 8 (4):421–43.

Kim, Youngwan, and Taehee Whang. 2017. ‘The Effects of the President’s Emergency Plan for AIDS Relief on the Economies and Domestic Politics of Focus Countries’. Global Economic Review 0 (0):1–23.

Kristiansen, Cathy. 2016. ‘PEPFAR’s Dr Deborah Birx Urges Sharper Focus to Halt HIV Globally - Fogarty International Center @ NIH’. Fogarty International Center 15 (1).

Kristof, Nicholas. 2017. ‘Nicholas Kristof: Meet the world leaders – in hypocrisy’. The Scotsman, 23 September 2017.

Lavers, Michael K. 2017. ‘World AIDS Day Used to Highlight HIV/AIDS Stigma, Discrimination’. Washington Blade: Gay News, Politics, LGBT Rights, 1 December 2017.

Lee, Barbara. 2017. ‘Opinion | How to Move Toward an AIDS-Free Generation’. The New York Times, 20 February 2017, sec. Opinion.

Leonhardt, David. 2017. ‘Opinion | America First, in Africa’. The New York Times, 9 February 2017, sec. Opinion.

Levey, Noam N. 2017. ‘Trump Pushes Historic Cuts in Global Health Aid, Stoking Fears of New Disease Outbreaks and Diminished U.S. Clout’. Los Angeles Times, 10 April 2017.

Mbanje, Phyllis. 2017a. ‘Health Ministry Frets over US HIV Funding’. NewsDay Zimbabwe (blog). 16 March 2017.

———. 2017b. ‘Glimmer of Hope as US Continues HIV Funding’. NewsDay Zimbabwe (blog). 15 May 2017.

McGreal, Chris. 2008. ‘George Bush: A Good Man in Africa’. The Guardian, 15 February 2008, sec. US news.

McKay, Betsy. 2017. ‘Health Sector Prepares for Antiabortion Policy’s Impact on HIV/AIDS Fight’. Wall Street Journal, 16 May 2017, sec. US.

Moucheraud, Corrina, Amee Schwitters, Chantelle Boudreaux, Denise Giles, Peter H. Kilmarx, Ntolo Ntolo, Zwashe Bangani, Michael E St. Louis, and Thomas J Bossert. 2017. ‘Sustainability of Health Information Systems: A Three-Country Qualitative Study in Southern Africa’. BMC Health Services Research 17 (January).

Mugyenyi, Peter. 2013. A Cure Too Far: The Struggle to End HIV/AIDS. Kampala: Fountain.

Nyakudya, Munesu. 2017. ‘Usaid Unveils $20m Grant for HIV Treatment’. NewsDay Zimbabwe (blog). 11 August 2017.

Nyaoke, Borna, Gaudensia N. Mutua, Rose Sajabi, Delvin Nyasani, Marianne W. Mureithi, and Omu A. Anzala. 2017. ‘Volunteer Motivators for Participating in HIV Vaccine Clinical Trials in Nairobi, Kenya’. PLOS ONE 12 (September):e0183788.

O’connor, Siobhan. 2017. ‘Brainstorm Health: The Future of HIV Vaccine Development’. Fortune (blog). 3 May 2017.

Okiror, Samuel. 2017. ‘End of Joseph Kony Hunt Breeds Frustration and Fear’. IRIN, 26 April 2017.

Onovo, Amobi, Temitayo Odusote, D Nongo, and H Kang. 2017. ‘Identification of Geospatial Hotspots of TB/HIV Co­infection Distribution in USAID/PEPFAR’. In . Guadalajara, Mexico.

Onovo, Amobi, Emeka Franklin Okechukwu, U Roxo, and H Kang. 2017. ‘Demographic Correlates of Survival in Adult HIV-Infected Patients Initiating First-Line Antiretroviral Therapy in Nigeria: A 7-Year Prospective Cohort Study’. In . Paris, France.

Opeyemi, Saheed Usman, Adebayo Fatai Kayode, and Usman Ibiwumi Nafisat. 2017. ‘O16.6 Willingness of Young Persons in South-Western Nigeria to Participate in Early Hiv Vaccine Trials’. In Sex Transm Infect, 93:A38.2-A38.

Osi, Bouaké. n.d. ‘Des Associations Condamnent La Politique Américaine “abstinence et Fidélit锑. Accessed 11 September 2017.

Provost, Claire. 2012. ‘Anti-Prostitution Pledge in US Aids Funding “Damaging” HIV Response’. The Guardian, 24 July 2012, sec. Global development.

Purvis, Katherine. 2017. ‘A Push to End the Global HIV Epidemic’. The Guardian, 9 August 2017, sec. Global Development Professionals Network.

Rabesandratana, Tania. 2016. ‘Promoting Abstinence to Prevent HIV Doesn’t Stop Risky Sex, Study Says’. The Guardian, 27 May 2016, sec. Global development.

Rosenberg, Tina. 2017a. ‘Opinion | In Africa, a Glimpse of Hope for Beating H.I.V.’ The New York Times, 19 September 2017, sec. Opinion.

———. 2017b. ‘Glimpse of hope for a continent’. Daily News, 22 September 2017, E1 edition, sec. LOR.

Rosenthal, Elisabeth. 2008. ‘Los Angeles Times Examines Effect of PEPFAR Drug Programs in Africa’. Kaiser Health News (blog). 15 February 2008.

Rushton, Mary. 2015. ‘IAVI Report - Six Prominent Women Scientists Making a Difference in the AIDS Fight’. IAVIReport 19 (2).

Russell, Asia. 2017. ‘Opinion | Trump and AIDS Relief’. The New York Times, 17 April 2017, sec. Opinion.

Saldinger, Adva. 2017. ‘Amb. Birx on PEPFAR in the Trump Era’. Devex. 14 March 2017.

Seib, Philip. 2017. ‘A Bush-Obama Alliance Might Save PEPFAR’. Huffington Post (blog). 9 April 2017.

Senthilingam, Meera. n.d. ‘HIV Vaccine to Be Trialled in South Africa’. CNN. Accessed 19 September 2017a.

———. n.d. ‘More Evidence Treatment Zeroes HIV Transmission during Sex’. CNN. Accessed 19 September 2017b.

Shelbourne, Mallory. 2017. ‘George W. Bush Pens Op-Ed Urging Full Funding for Anti-AIDS Program’. Text. TheHill. 8 April 2017.

Sieff, Kevin. 2016. ‘Tanzania Suspends U.S.-Funded AIDS Programs in a New Crackdown on Gays’. Washington Post, 23 November 2016, sec. Africa.

———. n.d. ‘Tanzania Suspends HIV/AIDS Programs in New Crackdown on Gays’. Accessed 8 September 2017.

Stolberg, Sheryl Gay. 2008. ‘In Global Battle on AIDS, Bush Creates Legacy’. The New York Times, 5 January 2008, sec. Washington.

Tehrani, Marjan, and Gabriel Noble. 2016. Ending AIDS Together - Full Documentary. Tru Films Production.

Tocco, Jack Ume. 2017. ‘The Islamification of Antiretroviral Therapy: Reconciling HIV Treatment and Religion in Northern Nigeria’. Social Science & Medicine (1982) 190 (August):75–82.

Varmus, Harold. 2013. ‘Making PEPFAR’. Science & Diplomacy, 01 2013.

Villarosa, Linda. 2017. ‘America’s Hidden H.I.V. Epidemic’. The New York Times, 6 June 2017, sec. Magazine.

Wang, Amy B. 2017. ‘Trump “simply Does Not Care” about HIV/AIDS, Say 6 Experts Who Just Quit His Advisory Council’. Washington Post, 19 June 2017, sec. To Your Health.

Warren, Rick and Kay. n.d. ‘Trump Budget Would Set Back Global AIDS Fight Just When We’re on Track to Win It’. USA TODAY. Accessed 6 September 2017.

Washington, Reuters. 2017. ‘Donald Trump Plans 28% Cut in Budget for Diplomacy, Foreign Aid’. Text. The Straits Times. 17 March 2017.

WHO. 2015. ‘Prevention of Mother-to-Child Transmission (PMTCT) of HIV’. AVERT. 20 July 2015.