URGENT: On Friday, February 9, a budget deal was signed that has the potential to result in deep cuts for foreign assistance programs depending on how funds are allocated. This would include PEPFAR, a program responsible for 2.2 million babies being born HIV-free, and so much more. Decisions will be made mid-February, one quick phone call or message from you can make a difference.
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How much do you remember about the world in January 2003? Personally, I was in sixth grade and very focused on try-outs for a local musical production of The Velveteen Rabbit. Let’s go back in time – Apple was still three months out from launching the iTunes store and four years from releasing the very first iPhone. The evening of January 28, interested Americans likely had to tune in live to watch the State of the Union address, as the launch of YouTube was still two years into the future and live punditry on Facebook and Twitter many more years beyond that.

When President George W. Bush entered the chamber of the House of Representatives I remember watching with my dad and listening with mild interest as he spoke on issues from education to the economy, many of which I didn’t fully understand. I did not know then that I would soon witness an announcement that would change the lives of millions and launch the United States as a leader in global health. However, this part of the speech, it still stands out to me:

“Today, on the continent of Africa, nearly 30 million people have the AIDS virus, including 3 million children under the age of 15. There are whole countries in Africa where more than one-third of the adult population carries the infection. More than 4 million require immediate drug treatment. Yet across that continent, only 50,000 AIDS victims —” [here, the president leaned forward and lowered his voice for emphasis] “only 50,000 — are receiving the medicine they need.”

As President Bush spoke, the chamber fell silent. President Bush continued to describe the scope of the crisis – and the scope of his ambitions to address it.

“Seldom has history offered a greater opportunity to do so much for so many. We have confronted, and will continue to confront, HIV/AIDS in our own country. And to meet a severe and urgent crisis abroad, tonight I propose the Emergency Plan for AIDS Relief, a work of mercy beyond all current international efforts to help the people of Africa. This comprehensive plan will prevent 7 million new AIDS infections, treat at least 2 million people with life-extending drugs and provide humane care for millions of people suffering from AIDS and for children orphaned by AIDS. I ask the Congress to commit $15 billion over the next five years, including nearly $10 billion in new money, to turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean.”

A New Plan, a New Era

The President’s Emergency Program for AIDS Relief (PEPFAR) was the catalyst for changing the prognosis for the global HIV/AIDS crisis, a renewal of hope for HIV-infected individuals, and the dawn of a new era in global health. This set the stage for the United States’ strong bipartisan legacy of bold initiatives to not only address HIV/AIDS, but also malaria, tuberculosis, and more.

Bold policy initiatives are not proposed in a vacuum – they are propelled and shaped by the advocacy of organizations like World Vision. At the time, World Vision staff and supporters had witnessed the devastating impact of HIV/AIDS, including its unique impact on children. However, a survey commissioned by World Vision in the year 2000 showed that more than half of evangelical Christians would not donate to help a child orphaned by AIDS. To combat the stigma associated with the disease, World Vision and other faith-based organizations launched groundbreaking efforts to educate people of faith and their churches about HIV/AIDS and move them to get involved by donating – and advocating for, complementary investments by the U.S. government. World Vision’s Hope Initiative, launched in 2001, shared stories of the impact of AIDS on children and families, reflecting on our scriptural call to care for widows, orphans, and the vulnerable. Events such as caregiver kit builds, to provide for those on the frontlines of the disease, “Hope Parties” to spread information about HIV/AIDS, and the World Vision Experience: AIDS traveling exhibit helped engage and move Christians in the U.S.

These efforts, alongside those of countless churches, faith leaders, and other faith-based organizations across the United States, were crucial to change Americans’ perception of HIV/AIDS and to create the political will for President Bush to propose PEPFAR and for a bipartisan coalition in Congress to support it. When President Bush took office, few imagined that he would make global health one of his administration’s signature priorities.

Changing the Numbers

The facts on HIV/AIDS are indisputable: The United States’ contributions to treat and prevent the disease over the past decade and a half have won historic gains against the epidemic. Global partners have been inspired to make further commitments and multiply the U.S.’ impact. Analysis by the ONE Campaign and the Kaiser Family Foundation total U.S. investments in PEPFAR at $80 billion to date, the largest-ever commitment by any nation to address a single disease. This has resulted in:

Perhaps the biggest transformation is the impact of HIV/AIDS on children. At the height of the epidemic, children were being orphaned at an alarming rate or left in the care of adults who were often sick as a result of HIV infection.  When PEPFAR was authorized by Congress in 2003, World Vision and other partners helped to ensure that 10 percent of PEPFAR funding was set aside to address the needs of orphaned and vulnerable children.

Commitments to the Most Vulnerable

Today, PEPFAR supports more than 6.4 million orphans, vulnerable children, and their caregivers. However, this doesn’t fully cover the 16.5 million children globally who have been impacted by losing parents or caregivers to HIV/AIDS. Continuing to dedicate 10 percent of PEPFAR funding to support these truly vulnerable children and their caregivers is a vital piece of the global AIDS response.

Innovative programming is characteristic of PEPFAR’s responsive model allowing areas of greatest need to be targeted. In response to growing evidence about the disproportionate level of new HIV infections among girls and young women, PEPFAR launched DREAMS in 2014: an ambitious partnership to reduce new HIV infections among adolescent girls and young women. The goal is for girls to be Determined, Resilient, Educated, AIDS-Free, Mentored, and Safe. In Uganda, World Vision has a goal to reduce new HIV infections among 45,000 adolescent girls as part of the DREAMS Innovation Challenge. As my colleague Lisa noted on a recent visit to a program site, “While part of the goal is to reduce the number of girls who get HIV, the project also works to address issues of child marriage, early pregnancy, violence at home and in the school, menstrual hygiene management, and other issues that can contribute to girls dropping out of school – a documented risk factor for increased rates of HIV.” This wrap-around approach is having a transformative impact.

The Impossible is Possible

Perhaps the most enduring impact of PEPFAR is helping us all to dream bigger. The program served as a catalyst for a major shift in the perspective and ambition of policymakers, researchers, health care providers, and the general public to address the HIV/AIDS crisis. An encompassing approach was embraced that allows more people to live out their full lives as God intended.

In 2003, when President Bush noted that just 50,000 HIV-infected individuals on the African continent were on treatment, then went on to propose a program that would aim to treat 2 million people and prevent infection in 7 million more, I suspect some lawmakers who publicly stood to applaud the proposal privately harbored doubts about its chances of success. I suspect they could not have imagined that this program would go on to save 11 million lives, inspire billions of dollars in commitments from other countries, and fundamentally alter our notion of what’s possible in global health. I am grateful for the men and women who did believe, those courageous enough to propose the seemingly impossible, and the faith of the policymakers who supported the beginning, of what could someday lead to the end, of the AIDS epidemic.

Help preserve this legacy. Ask Congress to maintain level funding for foreign assistance budgets.
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Photo: Princess Zulu and First Lady Laura Bush along with hundreds of volunteers assemble carekits during an event organized by World Vision and the One Campaign Tuesday, Sep. 2, 2008 at the Minneapolis Convention Center. The carekits provide essential medical supplies to people caring for those affected by AIDS in Africa, Asia, and Latin America. © World Vision 2008

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