The Impact of the President's Emergency Program for AIDS Relief (PEPFAR) on Children

BackgroundThe AIDS epidemic has had severe impacts on children causing 7.7 million child deaths and orphaning 15 million children. The impact would have been even greater if the PEPFAR program had not provided drugs and services to avert millions of new infections and AIDS-related deaths. This paper estimates the historical impact of PEPFAR support on children and projects the impact through 2030 if the PEPFAR program were to stop in 2024. MethodsWe used the Goals RSM HIV simulation model to project counterfactual scenarios of no PEPFAR support during both the historical period (2000-2022) and the future period (2024-2030). We applied the model to 53 countries receiving PEPFAR support. ResultsFrom 2004-2022 the PEPFAR program averted 2.8 million new child HIV infections, 1.5 million child HIV-related deaths and prevented 8.2 million children from becoming AIDS orphans. A continuation of PEPFAR at its current level through 2030 would avert one million new child HIV infections, 460,000 child HIV-related deaths and 2.8 million AIDS orphans. DiscussionThe PEPFAR program has been crucial to the success that has been achieved to date in the global fight against AIDS. That success has created an obligation. Continuation of PEPFAR is critical to the effort to achieve the end of AIDS in the coming years.