PEPFAR at 20 — A Game-Changing Impact on HIV

This perspective article evaluates 20 years of impact from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), launched in 2003 to address the HIV crisis in sub-Saharan Africa. Initially focused on expanding antiretroviral therapy (ART), PEPFAR has since evolved into the largest global health initiative targeting a single disease. Achievements include treatment access for over 20 million people, 27.7 million voluntary male circumcisions, prevention of 5.5 million perinatal HIV infections, and substantial declines in HIV incidence among adolescent girls via the DREAMS initiative. It strengthened health systems by training over 250,000 health care workers and supporting more than 70,000 facilities. The article also explores persistent challenges: disparities in service access, legal and social barriers for key populations, pediatric gaps in testing and treatment, and the need for integration with noncommunicable disease care. It advocates for country-led ownership and sustained investment to preserve gains and adapt to emerging global health needs.

This perspective article evaluates 20 years of impact from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), launched in 2003 to address the HIV crisis in sub-Saharan Africa. Initially focused on expanding antiretroviral therapy (ART), PEPFAR has since evolved into the largest global health initiative targeting a single disease. Achievements include treatment access for over 20 million people, 27.7 million voluntary male circumcisions, prevention of 5.5 million perinatal HIV infections, and substantial declines in HIV incidence among adolescent girls via the DREAMS initiative. It strengthened health systems by training over 250,000 health care workers and supporting more than 70,000 facilities. The article also explores persistent challenges: disparities in service access, legal and social barriers for key populations, pediatric gaps in testing and treatment, and the need for integration with noncommunicable disease care. It advocates for country-led ownership and sustained investment to preserve gains and adapt to emerging global health needs.