AIDS PEPFAR activists
Activists in front of the White House on Nov., 30, 2007, demand the U.S. government "remove political red tape" from its global HIV/AIDS programs. Credit: Win McNamee via GettyImages
Activists in front of the White House on Nov., 30, 2007, demand the U.S. government "remove political red tape" from its global HIV/AIDS programs. Credit: Win McNamee via GettyImages
Safe Blog

Twenty years of impact: Funding the fight to end AIDS by 2030

30th November 2023


  • Mia Mazer
    Mia Mazer

    Policy & Advocacy Officer,
    Together for Girls

  • Chrissy Hart
    Chrissy Hart

    Director of Policy & Advocacy; Regional Lead, Sub-Saharan Africa,
    Together for Girls

The US President’s Emergency Plan for AIDS Relief (PEPFAR) program is the most successful global health program in history. But right now, the stakes could not be higher for millions of adolescent girls and young women.

Who launched PEPFAR?

On January 28, 2003, President George W. Bush called for the creation of a new U.S. global HIV program in his State of the Union address.

Four months later, Congress passed authorizing legislation that established the President’s Emergency Plan for AIDS Relief (PEPFAR) program, including its structure and initial funding authorization levels.

Since then, PEPFAR has been reauthorized three times. It is widely recognized as the most successful global health program in history. For twenty successful years, it has reduced the incidence and prevalence of HIV among adolescent girls and young women.

Despite this incredible track record, its future remains in question. Even with a history of strong bipartisan support, there are challenges for U.S. Congress to pass a clean reauthorization of PEPFAR, which would ensure this program is fully funded for the next five years.

Currently, we are hopeful for a fourth reauthorization of the program. This is essential to maintaining the significant progress made toward achieving Sustainable Development Goal target 3.3: the end of AIDS by 2023 and continuing the work to end violence against children around the world.

A formidable partnership: PEPFAR and the VACS

Implemented as part of the Together for Girls (TfG) partnership, the Violence Against Children and Youth Surveys (VACS) are the largest global data source for violence against children, adolescents, and youth worldwide.

These surveys are led by national governments with technical assistance and support from the U.S. Centers for Disease Control and Prevention (CDC). The VACS is made possible in large part by PEPFAR, which has funded VACS in 16 countries.

The VACS provide data on 20% of the world’s youth under 24 living in lower-income countries.

Because of the VACS we have groundbreaking data measuring the prevalence, past 12-month incidence and circumstances surrounding sexual, physical and emotional violence in childhood, adolescence (before age 18) and young adulthood (ages 18-24 years). They provide important data on demographics and education, risk factors, protective factors, and consequences of violence as well as access to services for survivors.

Failure to reauthorize PEPFAR also puts funding for the Violence Against Children and Youth Surveys (VACS) at risk due to uncertainty in discretionary funding at the national level, curtailing the evidence base used to catalyze political will, policy and programmatic changes by governments, UN agencies, NGOs, and PEPFAR.

“We have seen a lot of changes compared to when we first entered the communities. We have seen adolescent girls and young women being able to make informed choices. They are more aware of the risk of HIV and the violence that they face, and now they are able to report and handle such issues.” – David, DREAMS implementer

Gender inequalities drive the HIV epidemic

While there have been substantial declines in new HIV infections globally, the largest global prevention and treatment gaps remain among adolescent girls and young women, children, and key populations.

Adolescent girls and young women are disproportionately impacted by the HIV/AIDS epidemic in many countries. They are up to 14 times more likely to become HIV-infected than their male counterparts, and in Sub-Saharan Africa, they account for 67% (or 280,000) of annual new HIV infections in young people.

In 2022, around 4,000 young women were infected with HIV every week.

Social isolation, poverty, discriminatory cultural norms, orphanhood, gender-based violence, and inadequate schooling all contribute to their vulnerability to HIV and a life not lived to its full potential.

"I always try to convince other mothers to let their children join DREAMS, because girls and mothers get help. When girls join DREAMS they are empowered to greater heights so I always tell mothers if you want your children assisted please join DREAMS". – Zuwena, mother of a DREAMS girl

PEPFAR's DREAMS initiative: Breaking the cycle of violence and HIV/AIDS

In 2014, PEPFAR established the ambitious public-private partnership, DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe). Through DREAMS, PEPFAR plays a unique role in reducing HIV/AIDS and preventing sexual violence among adolescent girls and young women in the highest HIV burden countries. To date, it has invested more than $2 billion in comprehensive HIV prevention programming.

Gender-based violence, exclusion from economic opportunities, and a lack of access to secondary school make adolescent girls and young women specifically vulnerable to HIV infection, with sexual violence an underlying, driving factor.

VACS data informs PEPFAR programming, especially the DREAMS partnership, to empower and support adolescent girls and young women and prevent HIV. The VACS provides essential data to help DREAMS countries plan for violence prevention and response programming as well as target interventions to adolescent girls and young women who are at highest risk of violence and HIV infection.

In 2022 alone, DREAMS reached 2.9 million girls through its HIV prevention services and programs, playing a critical role in continuing to reduce the burden of HIV among vulnerable populations.

The program reached over 1.4 million adolescent girls and young women through family planning counseling and referrals, and PEPFAR provided post-violence clinical care services to approximately 380,000 girls and young women.

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“My life had come to a standstill. I could not further my education and had gotten a child who I could not take care of. Being the first born, I felt a deep sense of shame and helplessness. DREAMS gave me a new lease of life – I have my confidence back, I’m independent, and can pay my siblings fees and house rent. I can now live AIDS-free.” – Vyona, DREAMS girl

Expired: Funding for orphans and vulnerable children

While there are permanent aspects of the policy framework for PEPFAR, there are provisions that have expired. Among them are the funding set aside for orphans and vulnerable children (OVC), which expired at midnight on September 30, 2023.

This mandated at least 10% of bilateral PEPFAR funds are spent on children who are orphaned, infected, or affected by AIDS.

This funding has critical benefits for girls in multiple ways, through DREAMS activities and socio-economic support.

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Extending a lifeline

PEPFAR has invested over $100 billion in the global HIV/AIDS response, saving 25 million lives, preventing millions of HIV infections, and supporting several countries to achieve HIV epidemic control.

If PEPFAR is not reauthorized by Congress, severe cuts to investments in children’s wellbeing will put millions of children in danger and reverse the program’s success over the last two decades. In particular, it will put millions of adolescent girls and young women at risk of HIV and prevent them from reaching their full potential. These cuts will also widen the gap between reductions in HIV infection among adolescent girls and young women and other vulnerable groups.

Sustained PEPFAR funding is essential to continued global progress on HIV and meeting the Sustainable Development Goal of ending AIDS by 2030. The leadership of the United States has and must continue to be a cornerstone of work to improve child safety and well-being. Congress must act to pass a clean five-year reauthorization of PEPFAR and ensure this lifeline is extended for the most vulnerable.

Learn more about DREAMS