PEPFAR-Treasury Collaboration to Combat HIV/AIDS in Sub-Saharan Africa

In addition to the direct human suffering and death toll associated with HIV/AIDS, the disease also has severe economic consequences. Often afflicting the heart of the working-age population, the illness -- especially when left untreated -- saps economy-wide productivity, keeps workers out of the labor force, disrupts investment, and undermines entrepreneurial energy.  Left unchecked, HIV/AIDS can devastate a country’s finances, crippling growth and turning back hard-won development gains.

This is why the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the U.S. Department of Treasury are seeking to broaden awareness of the substantial economic costs of the epidemic. 

PEPFAR has contributed to a reduction in annual HIV infections globally by nearly 40 percent. Yet more than 40,000 people are newly infected with HIV every week, and a large number of youth are entering the age group most susceptible to HIV infection.  Each new infection adds to the cost of controlling the disease.  Without new investments and greater program efficiency, the cost of combatting HIV/AIDS will exceed available local and donor resources. For poor countries, taking on a greater share of this fight is a difficult but necessary financial challenge in light of projections that donor financing for HIV/AIDS has plateaued.      

In this context, the U.S. government has initiated a dialogue with a set of African Finance Ministries and the international financial institutions. The goal is to help prepare public budgets to assume a greater share of the costs for HIV/AIDS programs, and to provide technical assistance to build state capacity in public financial management.

With the amount of international donor funding for HIV/AIDS having plateaued, we must use each available dollar more wisely. That is why PEPFAR is pivoting to target evidence-based interventions to the highest-burden populations and geographic areas for maximum impact. To achieve epidemic control, these efforts will need to be complemented by similar program shifts by the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), partner countries, and other donors.

To advance PEPFAR-Treasury cooperation, we co-hosted a roundtable with African Finance Ministers and other international partners during the World Bank/IMF Spring Meetings in Washington, D.C. to discuss the economic and fiscal challenges of the HIV/AIDS epidemic. We were joined by senior Finance Ministry representatives from Malawi, Mozambique, Uganda, and Zambia, along with senior representatives from the Joint United Nations Programme on HIV/AIDS (UNAIDS), the Global Fund, the IMF, and the World Bank. 

Analysis presented by UNAIDS at the meeting suggests that actions taken over the next five years are critical.  UNAIDS estimates that existing policies risk 2.5 million new HIV infections per year in 2030, whereas aggressive coordinated efforts by donors and national health and finance ministries aimed at a Fast-Track strategy to confront the disease could reduce new infections to as few as 200,000 per year.

The meeting marks the first of many important discussions -- among donors, between donors and partner country governments, and within partner country governments -- so that practical steps can be taken to deliver on the promise of a healthier and more prosperous future for the people of sub-Saharan Africa and around the globe.  

About the Authors: Deborah L. Birx, M.D., serves as the U.S. Global AIDS Coordinator and U.S. Representative for Global Health Diplomacy. Ramin Toloui serves as Assistant Secretary for International Finance at the U.S. Department of the Treasury.



United States
June 16, 2015
Greetings from Ngoketunjia AID Fighters (NAFI )- Cameroon. NAFI has existed and has supported people infected and affected especially by HIV/AIDS in many ways since 2001.Through trainings, experience sharing on disease management, directly material, financial, psychological, social , nutritional and medical assistance given the above targets, NAFIs main dream of helping in establishing an HIV/AIDS free generation has a long still to go in Cameroon due to lack of consistent partners in the realization of objectives. We hereby seek partnership and support from PEPFAR to assist us work towards our goal.
People Walk Past the IMF Headquarters as the IMF/World Bank Spring Meetings Begin
April 28, 2015


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