PEPFAR disruption could kill half a million children by 2030, study finds

Half a million children could die from AIDS by 2030 because of disruptions to the flagship US HIV prevention project PEPFAR, experts have warned.

Their analysis, published in The Lancet on Tuesday, estimates that one million additional children could be infected with HIV and almost half a million of them could die by the end of the decade if PEPFAR’s programmes are reduced or eliminated.

On top of the infections, some 2.8 million children could be orphaned by HIV-related deaths, they found.

PEPFAR was established by George W Bush, the US President, in 2003. So far, it has saved over 26 million lives, protected 7.5 million babies and supported 10 million orphans with HIV prevention and treatment.

Since its inception, the project has put more than $120 billion (£94 bn) into efforts to tackle HIV – the largest commitment by any nation in history to address a single disease. It operates in more than 50 countries around the world.

The support PEPFAR funding provides includes life-saving antiretroviral treatments for those with HIV, as well as antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV infection. It also supports voluntary medical male circumcisions, the training of health care workers, and HIV prevention services for girls and young women.

On January 20, Donald Trump signed an executive order halting these life-saving efforts. The decision followed news that several nurses funded by PEPFAR had performed illegal abortions in Mozambique.

Prof Lucie Cluver, co-lead author of the analysis, from the University of Oxford, was a social worker in South Africa before PEPFAR was introduced.

“My work was with dying children and mothers and I had nothing to give them. Then PEPFAR came and everything changed – it was like seeing a continent come to life again,” she told the Telegraph.

But the suspension of PEPFAR has thrown efforts to end HIV and AIDS into jeopardy, she said.

“Losing stable, long-term support for PEPFAR programmes sets global progress to end HIV/AIDS back to the dark ages of the epidemic, especially for children and adolescents,” she said.

Prof Cluver said a colleague had recently returned from the rural Copperbelt in Zambia and told her it felt like the clock had been turned back 25 years.

“They were seeing children with sores on their faces and mothers dying again,” she said.

The impact of PEPFAR extends beyond HIV and AIDS prevention – it also also supports many programmes working to improve child health and eliminate sexual violence against girls.

If these programmes end, there is a risk that the children they help will “slip through the cracks,” said Susan Hillis, a Senior Research Officer at Imperial College London and another of the report’s co-authors.

“[Reducing] sexual violence is one of the most fundamental things PEPFAR has done,” Prof Cluver added. “It’s often how young girls are contracting HIV and those who have been victimised get mentorship, counselling and support. Losing it would be catastrophic.”

The researchers urged the US to support a five-year transition plan instead of stopping PEPFAR immediately, so that responsibility for its programmes can be taken on gradually by African governments.

“What is urgently needed now is a well-planned transition to expanded country-ownership of PEPFAR programmes that will offer stability for countries that currently rely on PEPFAR support,” said co-author Prof Chris Desmond, of the University of Kwazulu-Natal.

Prof Cluver told the Telegraph that, if PEPFAR is terminated, the country most affected will be the US itself.

“PEPFAR is so important to the way the US is viewed globally. It is the reason why the US has such strong trade and diplomatic relations with Africa. I hope they’ll make the right choice.”

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