Since former President George Bush launched the programme in 2003, it
has been widely praised as the largest and most ambitious health
initiative dedicated to combating a single disease, but until recently
the outcomes of this multibillion-dollar effort had never been
Using figures from UNAIDS, researchers from Stanford University in the
US compared HIV-related deaths, the number of people living with HIV,
and HIV prevalence in 12 "focus" countries, selected by PEPFAR to
receive funding, with 29 other countries in sub-Saharan Africa that are
also experiencing generalised HIV epidemics.
They found that in the four years after PEPFAR’s activities started,
the annual number of HIV-related deaths in the focus countries was 10.5
In an article published on the website of the Annals of Internal
Medicine, the authors of the study noted that nearly half of PEPFAR’s
expenditures went to providing antiretroviral (ARV) treatment, and that
better ARV treatment coverage in the focus countries probably accounted
for the lower death rates.
Based on the more than US$6 billion that PEPFAR had spent in the 12
countries by the end of 2007, the researchers estimated the cost of
each death averted at $2,450.
In the focus countries, a slightly steeper increase in the number of
HIV-positive people might also have been because those on ARV treatment
were living longer.
However, the researchers found no evidence that PEPFAR’s activities had
affected prevalence rates. About one-fifth of PEPFAR’s resources were
spent on prevention programmes during the study period, of which
one-third were earmarked for abstinence-only programmes.
The authors raised the concern that, as the number of people receiving
life-long ARV treatment in the focus countries increased, the cost of
treatment would become unsustainable unless the number of new HIV
infections could be substantially reduced.
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