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DOI: 10.1377/hlthaff.2012.0684
Five years ago I had the inestimable privilege of visiting several East African programs sponsored by the President's Emergency Plan for AIDS Relief, or PEPFAR, the subject of this thematic issue of Health Affairs. In Rwanda, I met Winifred Mukagihana, then 48 years old.
One of the many ethnic Tutsi victims of that country's unspeakable genocide in 1994, she had suffered almost beyond description. Her husband and two of her three children had been killed. Imprisoned, and pregnant, she had been repeatedly raped by her Hutu captors, at least one of which infected her with HIV. Another cut her Achilles tendons so she could not run away. When her baby was finally born, it was attacked and eaten by roving dogs.
Yet when I met her in 2007, Mukagihana was alive, and grateful. Living with the support of a Rwandan genocide widows' association that was an implementing partner of PEPFAR, she was receiving antiretroviral drugs through the organization's clinic. "We really need to thank God for that, because if we didn't get those drugs, ...I would no longer be alive," she told me.
'aids-free generation'
To this day, I have trouble expressing in words how moved and grateful I am as an American that our country, for all its foibles, launched and sustained PEPFAR. Granted, the US response to the global HIV pandemic was late in coming; millions died in poor countries even as those infected with HIV in Western nations routinely went on lifesaving treatment. But when the United States finally acted, the result was nothing short of extraordinary.
As Michael Merson and colleagues note in their overview of PEPFAR, no single country "has invested more resources in the prevention and treatment of HIV/AIDS than the United States." Along with the Global Fund to Fight AIDS, Tuberculosis, and Malaria, PEPFAR is a primary source of support for nearly seven million people receiving antiretroviral treatment worldwide. Now, if the United States can overcome some of our remaining foibles-primarily fiscal ones-we stand a chance of achieving what's been described as an "AIDS-free generation," the term Secretary of State Hillary Rodham Clinton employed in a November 2011 speech.
'think big'
Those unfamiliar with the PEPFAR saga can begin with John Donnelly's Report From The Field,...