American generosity has saved 25 million lives and counting. Let’s reauthorize PEPFAR now

The American people have shown time and time again that they are capable of extraordinary generosity, compassion, and leadership. In few places is this more evident than in our efforts to combat HIV/AIDS through the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR. 

President George W. Bush launched PEPFAR in his State of the Union address in 2003, saying, “Seldom has history offered the opportunity to do so much for so many.” These were bold words, and many questioned whether we could change the course of the AIDS epidemic. At that moment, AIDS was devastating sub-Saharan Africa. Families would carry their dying loved ones in wheelbarrows to hospitals where patients lay three to a hallway gurney. Nearly 30 million people were living with HIV, but only 50,000 had access to life-saving treatment. For most, HIV was a death sentence.  

Twenty years later, due to a bold vision, American generosity, and the support of every president and Congress since George W. Bush initiated the program, PEPFAR has saved more than 25 million lives. It has changed the course of history.   

Through PEPFAR, more than 20 million people now receive life-saving medicine. Mother-to-child transmission of HIV has been reduced by 80 percent, and 5.5 million babies of mothers living with HIV have been born HIV-negative. Care and support have been provided to more than 7 million orphans and vulnerable children impacted by the AIDS epidemic. Sixty-five million people have received HIV testing services, and millions of adolescent girls and young women have been reached with HIV prevention services. 

PEPFAR is not just a success story in the fight against HIV/AIDS — it is a model for how the United States can work with other countries and partners to tackle some of the world’s most pressing health challenges. By strengthening health systems, training more than 340,000 health care workers, and promoting sustainable national capacity, PEPFAR has helped prepare us for future pandemics and health threats. Through the nimble, effective, and efficient platform built over the last two decades, PEPFAR countries have been able to respond quickly to emerging health crises like Ebola, H1N1, and COVID-19. Clearly, the impact of PEPFAR has been felt far beyond the developing world, helping to prevent the spread of deadly disease across the globe. Furthermore, American investment led dozens of other countries to join the fight against AIDS through the Global Fund to Fight AIDS, Tuberculosis and Malaria, and we spurred the development of widely available and affordable HIV testing and therapeutics that have allowed millions with HIV to live safely and symptom-free.  

Today, many youth are no longer growing up in an era where selling coffins by the road is a booming business—but our work is far from done. In 2021, an estimated 410,000 people between the ages of 10 and 24 were newly infected with HIV. HIV education remains vital for a new generation of young people who were not yet born when AIDS ravaged the continent in the 1990s. PEPFAR, in partnership with organizations like the Elton John AIDS Foundation, is looking to expand digital innovations to reach young people in Africa. Given the continent’s youth bulge, the importance of reaching young people will only grow in the next decade.   

In sub-Saharan Africa alone, an estimated 280,000 new HIV infections are occurring in adolescent girls and young women every year. Through the DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) public-private partnership, PEPFAR provides these girls and young women with the skills and services needed to prevent new HIV infections by supplying preventative medicine, like pre-exposure prophylaxis, or PrEP; treating existing infections; combating violence against women; and building productive futures. These girls and young women can now dream of achieving their goals without the shadow of HIV looming over their lives. By continuing to invest in programs like DREAMS, we can create a future where all young people have the opportunity to reach their full potential. 

PEPFAR needs to be reauthorized this year, and we must reaffirm our commitment to this vital program. Over the past 20 years, PEPFAR has received broad bipartisan support from 10 Congresses and four administrations. Few efforts have received such deep, longstanding backing.  

We must come together once again to reauthorize PEPFAR and work to end AIDS as a public health threat by 2030. Now is the time to remind the world what American leadership can accomplish when we put our minds and hearts to it.  

Chris Coons is chairman of the Senate State, Foreign Operations, and Related Programs Appropriations Subcommittee, Lindsey Graham is ranking member of the Senate State, Foreign Operations, and Related Programs Appropriations Subcommittee. John Boozman and Chris Van Hollen are members of the subcommittee.