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SOWETO, SOUTH AFRICA—The Perinatal HIV Research Unit (PHRU) at the sprawling Chris Hani Baragwanath Hospital here is abuzz with activity. Young women with swelling bellies wait in plastic chairs to see nurses while pharmacists distribute antiretroviral drugs from an office behind a metal security gate. Upstairs, a fresh coat of paint is being applied to the walls of a new men's clinic that offers HIV-testing, support and treatment.
In the late 1990s PHRU pioneered research into using antiretroviral drugs to prevent and treat HIV, the virus that causes AIDS, in developing countries. Today, it is a model of how funding from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR)—more than $18.8 billion since 2004—has radically changed the global fight against AIDS and helped put more than 1.7 million people, mostly in Africa, on life-prolonging antiretroviral treatments who otherwise would likely have died.
The United Nations estimates that in 2007 (the latest year for which stats are available), 33 million people around the world were HIV-positive. Twenty-two million of those people are in sub-Saharan Africa. PEPFAR targeted 15 of the world's hardest hit countries in Africa, Asia and the Caribbean.
Once mostly a research institution, the PHRU now supports programs providing antiretroviral treatment for 30,000 HIV-positive people in four South African provinces and provides palliative care to some 30,000 others. In the township of Soweto, it has reduced the transmission rate of HIV from pregnant women to their newborns from about 25 percent in 2000 to around 5 percent today, protecting nearly 2,000 babies a year. The mothers and their infants are treated with antiretroviral drugs, meds designed to block viruses like HIV from replicating.
When Pres. Bush launched PEPFAR in 2003, pledging to give $15 billion over five years to fight global AIDS, many in the international AIDS community greeted the new program with skepticism. Critics slammed earmarks for abstinence-focused prevention programs and for expensive, brand-name antiretroviral drugs. The Bush administration was also hit for forking over only 16 percent, about $3 million, to the Geneva-based Global Fund to fight AIDS, TB and Malaria. The international community created the fund in 2001 to boost and coordinate funding for the three diseases.
But five years later, the program is widely viewed by development and public health experts as a success story. PEPFAR specifically is credited with helping to make antiretroviral therapy a reality in many of the world's hardest-hit countries. (Tests are now underway to see whether the drugs can also be used as a prophylaxis in HIV-negative people.)
"If we didn't have PEPFAR, we'd be lucky to have half as many people on treatment as we do at the moment," says Francois Venter, a physician and president of the Southern African HIV Clinicians Society in Johannesburg. "It forced everyone involved to be very focused on the endpoint: how many people tested, how many people treated," adds Venter, who also heads a PEPFAR-funded program at the University of the Witwatersrand's Reproductive Health and HIV Research Unit in Johannesburg.
Without PEPFAR, Norah Mahlangu insists her 10-year-old son might well be an orphan. The 27-year-old HIV-positive woman from Soweto is slowly crawling back from the edge of death with the help of Susan Moloto, a nurse at the Soweto Hospice whose annual salary is paid with PEPFAR funds. Moloto visits Mahlangu each week and has helped shepherd her patient through treatment for tuberculosis as well as enroll Mahlangu in an antiretroviral therapy program.