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.
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.
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.
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.
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.
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.
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.
"I have a good job that enables me to take care of my child and family. Thank you DREAMS."
"I now live in my own house and my sisters are back at school. Thank you for giving me hope."
“I am now a rice farmer who is independent and can fight for my rights and those of others.”
"When my dream of becoming a teacher came true, everyone in my community, including my husband, was very proud."
“I am grateful to be able to afford to buy my medication and earn a living at the same time."
"I now make hair locks, get paid and save, and hope to have a salon of my own. Getting involved with DREAMS gave me hope and skills to become independent.”
Learn about the intersection of sexual violence against girls and HIV in this fact sheet.