From 66,500 to 20 Million: How PEPFAR Scaled Up HIV Treatment, and Who Is Still Left Behind

In 2004, 66,500 people were receiving HIV treatment through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). By 2022, more than 20 million were — an increase of 300 times. Twenty years ago, in many countries, an HIV diagnosis almost certainly meant death; when PEPFAR began, only 50,000 people in Africa were on HIV treatment.

People on HIV treatment through PEPFAR, 2004 and 2022. CDC.

What PEPFAR is, and CDC's part in it

PEPFAR was announced in 2003 and began expanding HIV treatment a year later. At launch it was the largest commitment by any nation to address a single disease in history, made while HIV was devastating families, communities and economies, above all in sub-Saharan Africa.

CDC is PEPFAR's lead public health agency, working in more than 50 countries with more than 30 years' experience. With its governmental and non-governmental partners, CDC supports 62% of everyone on PEPFAR-supported treatment.

Why treatment is prevention

Effective treatment lets people with HIV live longer, healthier lives — and it does more. A person who is virally suppressed has the virus under control thanks to treatment, which can prevent transmission to sexual partners and reduces the risk of transmission from mother to child. Fewer transmissions mean fewer new infections overall, which is why access to treatment is central to eliminating HIV.

Among people on PEPFAR-supported treatment who had a viral load test, the share who were virally suppressed rose from 80% to 95% by 2022.

Viral suppression among people on PEPFAR-supported treatment. CDC.

What it looks like in a country

The same investments built capacity beyond HIV. Through PEPFAR, CDC has strengthened laboratory systems, trained and supported health care workers, improved disease monitoring, and deepened long-standing ties with ministries of health and local partners — capacity that helped countries respond to COVID-19 and will help with future threats, protecting Americans at home and abroad.

Who is still left behind

• Viral suppression lags among people who are pregnant or breastfeeding, children, adolescents and people in prisons.
• It is lower in men than women, and in younger than older people.
• Key populations — gay and bisexual men, female sex workers, people who inject drugs, people in prisons, and transgender people, primarily transgender women — face stigma, discrimination and social inequities that keep them from treatment and prevention.
• At the end of 2021, almost 15% of people living with HIV did not know their status, nearly 10 million people with HIV were not getting treatment, and 1.5 million had newly acquired HIV.

The 2030 goal

Under PEPFAR's five-year strategy, the United States aims to eliminate HIV as a global public health threat by 2030. CDC set out four things it will take:

1. Sustain the effort and the investment, or risk reversing decades of progress — patient-centered, data-driven programs and the tools proven to cut infections and deaths.
2. Advance health equity, reaching the groups still left behind.
3. Strengthen health systems through PEPFAR's platforms, for global health security.
4. Build partnerships across governments, communities, patients, public health and private enterprise.

Sources

Based on "Eliminating HIV as a Global Public Health Threat," CDC Vital Signs, March 2023, Centers for Disease Control and Prevention, which summarizes the MMWR report "Progress Toward Eliminating HIV as a Global Public Health Threat through Scale-Up of Antiretroviral Therapy and Health System Strengthening Supported by the U.S. President's Emergency Plan for AIDS Relief — Worldwide, 2004–2022"; a work of the United States government in the public domain. The source dates the start of the viral-suppression figure to both 2015 and 2016, so no start year is given here.