- What does PEPFAR do?
- Who, specifically, does PEPFAR help?
- How much does PEPFAR cost?
- How do we know whether PEPFAR is working?
- Why is America doing HIV/AIDS work in the first place?
The President’s Emergency Plan For AIDS Relief (PEPFAR) provides funding to prevent and treat HIV/AIDS in low- and middle-income countries. For the first twenty years of its history, it was popular and bipartisan, the shining jewel of US aid programs. But right now, many PEPFAR programs are paused, clinics are shuttered, and the upcoming reauthorization fight looks uncertain. The State Department, which administers PEPFAR, says the program has saved 25 million lives. We are an independent team of journalists, academics, and technologists who decided to investigate whether that was true.
Our key findings:
- PEPFAR has saved between 7.5 and 30 million lives, at a cost between $1,500 and $10,000 per life saved. The US government is willing to spend at least a thousand times this much to save an American life.
- In Africa, unlike in the United States, HIV/AIDS primarily affects women and children. One of the main goals of PEPFAR is to prevent “vertical transmission”, where a pregnant mother with HIV passes on her infection to her baby in utero or during delivery. PEPFAR has prevented at least 5.5 million babies from being born with HIV.
- The number of people who die of HIV/AIDS each year has been declining since 2004–the year PEPFAR began operation. PEPFAR is a major reason for this decline.
- PEPFAR helped decrease the cost of first-line HIV medications from $1000 a month to only $60 a year ($5 a month). Because of the declining cost of medications, PEPFAR is more cost-effective each year, and is doing more and more on a budget that has been declining in real dollars since 2009.
- PEPFAR also offers post-exposure prophylaxis to nurses, rape victims, and others exposed to HIV, and pre-exposure prophylaxis, medications that prevent contracting HIV, to women whose husbands have HIV and other at-risk populations.
- Over time, PEPFAR is handing off its responsibilities to the governments of the countries we’re helping, but it will take decades if we want to defeat HIV/AIDS and years if we want to not destroy the good works we have already done.
- PEPFAR is a well-audited program. The audits we spot-checked showed 0 to 2% rates of undocumented program expenses. This compares extremely favorably to other government programs: the Medicare fraud rate, for instance, is reportedly 5-10%.
- Controlling HIV/AIDS abroad keeps Americans safe from HIV/AIDS at home. The federal government spends $29 billion annually on medical care for Americans with HIV and AIDS, not counting insurance company spending: six billion for PEPFAR is a good deal.
by Kelsey Piper, Leah Libresco Sargeant, Colin Aitken and others, PEPFAR Report | Read more:
Image: Our World In Data
[ed. If there's one benefit to be gained from all the blundering and idiotic 'cost cutting' this administration is currently engaged in, it's that people are becoming more aware of all the good and essential things our government does, which go unnoticed most of the time. PEPFAR Impact Counter tries to estimate the number of people affected by its closure, and says that 13,854 adults and 1,474 infants have already died from this policy. What about everything else? Here's one perspective:]
"I’m really pessimistic about all this. I think the main effect will be saving ~1% of the budget at the cost of causing so much chaos and misery for government employees that everybody who can get a job in the private sector leaves and we’re left with an extremely low-quality government workforce. I freely admit that DEI also did this, I just think that two rounds of decimating state capacity and purging high-IQ civil servants is worse than one round. In fact, this is what really gets me - both parties are careening towards destruction in their own way, there’s no real third option (...)
Probably nothing catastrophic happens for the first few years of this. The cuts to clinical research mean we get fewer medications. The cuts to environmental funding mean some species go extinct. The cuts to anti-scam regulators means more people get scammed. But the average person has no idea how much medical progress we’re making, or how many species go extinct, or how many people get scammed in an average year. Maybe there will be some studies trying to count this stuff, but studies are noisy and can always be dismissed if you disagree. So lots of bad stuff will happen, and all the conservatives will think “Haha, nothing happened, I told you every attempt ever to make things better or dry a single human tear has always been fake liberal NGO slush fund grifts”.
Or maybe one newsworthy thing will happen - a plane will fall out of the sky in a way easily linked to DOGE cuts (and not DEI?), or the tariffs will cause a recession, and then all the liberals will say “Haha, we told you that any attempt to reduce government or cut red tape or leave even the tiniest space for human freedom/progress has always been sadistic doomed attempts to loot the public square and give it to billionaires!” They’re already saying this! Everyone is just going to get more and more sure that their particular form of careening to destruction is great and that we can focus entirely on beating up on the other party, and we will never get anyone who cares about good policy ever again.
Probably this isn’t true, and I shouldn’t even say it because everyone else is already too doomy. You’d be surprised how many basically sane people I’ve heard expressing worries they’ll being put in camps (not even illegal immigrants or some other at-risk group!), or that Elon Musk sending people emails asking them what they’re doing is a form of fascism. I try to remind myself that if there had only ever been half as much government funding as there is now, I wouldn’t be outraged and demand that we bring it up to exactly the current level (and, once it was at the current level, become unoutraged and stop worrying). The current level is a random compromise between people who wanted more and people who wanted less, with no particular moral significance. This thought process helps, but I think that even in that situation one could justify a few really good programs like PEPFAR on their own terms (ie if it didn’t exist, I would be outraged until it did), and I still think that changing the size of government should be done through legal rather than illegal means, competently rather than incompetently, and honestly rather than lying about every single thing you do all the time."
