On this World AIDS Day 2024, we here at First Focus on Children wish to pay tribute to the groundbreaking work of PEPFAR, the President’s Emergency Plan for AIDS Relief, and to call for its clean five-year reauthorization by Congress.
As an advocacy voice for children in the U.S. and worldwide, we wish in particular to highlight PEPFAR’s leadership on behalf of kids. Although it is better known for its medical achievements of saving the lives of 26 million men, women, and children over the past 21 years, enabling 7.8 million babies to be born HIV-free, and turning a deadly pandemic into a manageable disease, PEPFAR was and continues to be one of the premier children’s socio-economic support programs worldwide. Since its inception, PEPFAR has protected and cared for millions of orphans and other children made vulnerable by AIDS. It has done this by strengthening their families thereby enabling children to remain protected from sickness, abuse and trafficking.
How It Started
In 2003, a bipartisan group of House and Senate lawmakers came together to ensure the protection and care of children hardest hit by the HIV pandemic, especially those whose parents were sick and unable to care for them or had passed away. Senators Durbin (D-IL), former Senator Lugar (R-IN), Representatives Barbara Lee (D-CA), Betty McCollum (D-MN), former Representatives Tom Lantos (D-CA) and Henry Hyde (R-IL) offered an amendment during the legislative authorization process to set aside 10% of overall PEPFAR funding for the care and protection of orphans and vulnerable children (OVC). And since 2003, Congress has continued to set aside 10% of PEPFAR funding for OVC at every subsequent reauthorization of the program with the specific intent that the OVC set aside be used exclusively for the socio-economic parenting and protection services that mitigate the harm of HIV on infected, affected and at-risk children, adolescents and their families.
How It’s Going
Over the past 20-odd years, the OVC set aside has become known as the gold standard for the best way to support and protect the most vulnerable children and adolescents globally. This is because the HIV community has found through decades of community-level HIV implementation that barriers to testing, treatment, and adherence to treatment for children living with and orphaned by HIV cannot all be addressed through clinical interventions. Instead, it has been through OVC programming that PEPFAR has tackled barriers such as inadequate nutrition to support adherence, parenting education for caregivers of children living with HIV, home visits to support testing and adherence to treatment, and lack of financial assets for families to ensure their children reach the clinic and remain on treatment.
Addressing these barriers is critical to ensuring that children who are diagnosed HIV positive remain on treatment and to detect and enroll undiagnosed infants and children. And the alternative is heartbreaking: without treatment, 50% of HIV-positive children will die before their second birthday and 80% will die by age five.
The programs funded by PEPFAR’s OVC set aside have proven to be visionary in solving the complicated puzzle of HIV’s negative impact on child social, health, and economic well-being and are needed now more than ever. While AIDS is no longer a death sentence on the African continent thanks to PEPFAR and its partners, the number of orphans (children aged 18 and younger who have lost one or both parents to AIDS) has grown, from 12.4 million when PEPFAR was created to 14.1 million in 2023. And these millions of children remain at grave risk. AIDS puts a tremendous strain on all aspects of socio-economic and health outcomes in an affected community and greatly increases the threat of violence against children and sex trafficking, as familial protections for children break down. PEPFAR’s OVC parenting programs have been shown to reduce sexual violence against children by 37%.
PEPFAR is currently supporting over 6.6 million orphans and vulnerable children and their caregivers with interventions that ensure affected children enjoy good nutrition, access to school and psychosocial support to address stigma, and that their caregivers have access to savings and livelihood support. These holistic services keep children’s families together and functioning and acting as a protective shield against harm around children.
What’s Next
Going forward it is critical that PEPFAR continue this support and refrain from siphoning off these precious resources for other priorities. (Every few years there is a push in this direction as funding allocations from Congress remain stagnant and UN goals for 2030 draw closer.) The10% set aside for OVC must remain separate but complimentary to PEPFAR’s pediatric treatment work because it is the only pot of money that allows community health workers to help vulnerable families navigate the stigma, poverty, violence, and social and legal systems that may otherwise pose insurmountable hurdles to accessing and remaining on treatment and protecting vulnerable children from harm.
PEPFAR’s OVC programs play a key role in finding HIV-positive children, getting them tested, and accompanying them to ensure adherence to treatment regimens. OVC programs also provide caregivers with access to livelihoods thereby strengthening families around vulnerable children and ensuring they do not end up on the street. With over 14 million Orphans from AIDS in the world, 1.4 million children needing home support for treatment, and millions more adolescent girls requiring prevention interventions, the set aside for socio-economic support is needed more than ever.
And, it is important to keep in mind, that while PEPFAR has made tremendous strides for children, (by preventing mother-to-child transmission, increasing the percentage of children on treatment, and with its OVC work discussed above), let us not forget that overall children in large part continue to be left behind when it comes to resources and child-friendly policies and interventions. Because, although children make up 30-50 %of the population of most poor countries, U.S. foreign assistance only provides them 10 % of the overall share of foreign aid resources. Global HIV numbers show a similar picture of children being an afterthought: just 57% of infected and diagnosed children are being treated, versus roughly 77% of adults. And while children (0–14 years old) represent only 3% of people living with HIV, they account for 12% of AIDS-related deaths—one in eight people who died due to AIDS in 2023 was a child. Indeed, children rarely receive their fair share of any pie or are overlooked altogether, and that is why it is paramount that any added interventions on behalf of children that PEPFAR takes on (which we would strongly support) be made in addition to its current care and support of orphans and vulnerable children, and not at their expense.
Call To Action
Again, we urgently call on Congress for a clean five-year reauthorization of PEPFAR. We also call for full funding of PEPFAR in next year’s annual appropriations process. PEPFAR’s achievements are historic and its protection of orphans and other vulnerable children against the worst aspects of AIDS is a source of great pride for our country and all partners who contributed to its efforts.