A Decade of PEPFAR and Young People: What’s Working and What Isn’t


PEPFAR (the President’s Emergency Plan for AIDS Relief) turns ten on May 27, the date when President George W. Bush signed it into law. It’s a remarkable milestone given that many global health and development programs never make it out of their infancy. With the program now entering its pre-teen years, it’s the perfect time to take stock of its efforts to reach young people in their second decade of life.

Over the past ten years, we have witnessed dramatic scientific advances in the fight against HIV and AIDS, spurring renewed hope that the end of AIDS is in sight. These advances, coupled with the U.S. government’s Blueprint for Achieving an AIDS-Free Generation and the recently released Institute of Medicine evaluation of PEPFAR, offer real promise for the way forward.

This promise, however, is in real jeopardy. Several years of level and/or decreased funding threaten the successes PEPFAR has achieved to date. While politicians wrangle over funding and policy decisions in Washington, HIV continues to take its toll on families, communities, and nations, particularly among young people. Despite declines in HIV prevalence among young people in recent years, 15-to-24-year-olds continue to account for four in ten new infections around the globe. This is simply unacceptable.

While steps toward advancing young people’s sexual health have been made, progress has been hampered by a siloed, segmented approach that fails to address the holistic needs of youth or to engage young people themselves as partners in prevention. What is needed, what is smart, and what is widely proven more effective, is to require comprehensive programs which teach young people about correct and consistent use of condoms, in addition to abstinence.

PEPFAR should take some recent improvements to the next level. Since family planning is an essential component of the HIV response, PEPFAR should allow funds to be used on prevention methods other than condoms. PEPFAR has also only recently acknowledged that some young people are also members of key affected populations (such as men who have sex with men, sex workers, and people who inject drugs) and that we must now take the next step to reach young people with targeted interventions that meet their needs.

And our efforts, no matter how well-intentioned, are wholly inadequate and ineffective if we fail to address the structural drivers of the epidemic—drivers which disproportionately impact women, girls, and key affected populations. To address these barriers, PEPFAR must do a better job of supporting multi-sectoral approaches that improve girls’ access to education, increase economic opportunities for women and young people, prevent and respond to sexual- and gender-based violence, engage men and boys, invest in youth leadership and advocacy, and support the human rights of young people, particularly young people living with HIV and AIDS, young women, and young key affected populations.

On World AIDS Day last year, then-Secretary Clinton stated, “Now, make no mistake about it: HIV may well be with us into the future. But the disease that it causes need not be.” In order for that to be absolutely true, we can and must do better by our young people.

We must ensure that programs for young people are comprehensive, evidence- and rights-based, and inclusive of the diversity of youth. We must allocate sufficient resources—financial, technical, and human—to best address youth within the HIV pandemic. We must address the underlying social and cultural determinants that place young people at risk. And we must absolutely ensure that young people themselves are meaningfully engaged in all program and policy decisions impacting them.

As we celebrate the many incredible successes PEPFAR has brought us in its first ten years, I offer many heartfelt wishes for even more in its next ten years. Happy birthday, PEPFAR!

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