The Mismatch Between the Rhetoric and Reality of Tillerson’s New PEPFAR Strategy

The Mismatch Between the Rhetoric and Reality of Tillerson’s New PEPFAR Strategy
Civil rights activists march at the start of the 21st World Aids Conference, Durban, South Africa, July 18, 2016 (AP photo).

The President’s Emergency Plan for AIDS Relief, or PEPFAR, is sometimes described as George W. Bush’s signature policy achievement—a rare bright spot on a decidedly fraught record, especially overseas. Active in more than 50 countries, many of them in sub-Saharan Africa, the program has been essential in the effort to bring the continent’s HIV/AIDS epidemic under control.

Yet the program’s future seemed to be in jeopardy following Donald Trump’s election last November. In January, a list of questions formulated by his transition team sparked concern among those working on foreign assistance in sub-Saharan Africa—and HIV/AIDS programming in particular. “Is PEPFAR worth the massive investment when there are so many security concerns in Africa?” the questionnaire read. “Is PEPFAR becoming a massive, international entitlement program?”

To experts familiar with the program, the questions seemed strikingly wrong-headed, especially in light of what PEPFAR has achieved. As of last year, the program was supporting antiretroviral treatment, or ART, for 11.5 million people globally; when PEPFAR began, only 50,000 people in all of sub-Saharan Africa were receiving ART. And it has helped guide several African countries that were previously ravaged by HIV/AIDS to the point of “epidemic control,” defined as when the total number of new infections drops below the total number of deaths

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