Evaluating the President's Emergency Plan for AIDS Relief: Time to Scale It Up

In 2003, the U.S. government embarked on the largest public health program ever created by 1 country to fight a single disease: HIV/AIDS. The nucleus of the program, framed in the context of urgent need, was aptly named the President's Emergency Plan for AIDS Relief (PEPFAR). The initial goals of PEPFAR were to confront HIV and AIDS on multiple fronts by scaling up services to prevent vertical and horizontal HIV transmission, to provide medical therapy through the procurement and distribution of antiretroviral and ancillary drugs, and to support care for HIV-uninfected persons whose lives had become unstable because of HIV/AIDS. Although PEPFAR money flows to more than 120 nations, 15 focus countries, 12 of which are in Africa, get most of the money. From the beginning, PEPFAR has been a goal-driven program, with initial 5-year performance targets of providing antiretroviral therapy to 2 million people, preventing 7 million new HIV infections, and delivering supportive care to 10 million people affected directly or indirectly by HIV/AIDS (1). Initially conceived as a moral imperative, PEPFAR was historic in both its scale and the compressed time scale for meeting its objectives.

In this issue, Bendavid and Bhattacharya (2) report their attempt to measure the effects of PEPFAR by comparing trends in AIDS-related death rates and HIV prevalence rates in 12 PEPFAR focus and 29 nonfocus African countries with a generalized HIV epidemic. Using data from the joint United Nations Programme on HIV/AIDS spanning 1997 …