The Impact of the President’s Emergency Program for AIDS Relief (PEPFAR) on Children

Background The AIDS epidemic has had severe impacts on children causing 7.7 million child deaths and orphaning 15 million children. The impact would have been even greater if the PEPFAR program had not provided drugs and services to avert millions of new infections and AIDS-related deaths. This paper estimates the historical impact of PEPFAR support on children and projects the impact through 2030 if the PEPFAR program were to stop in 2024. Methods We used the Goals RSM HIV simulation model to project counterfactual scenarios of no PEPFAR support during both the historical period (2000-2022) and the future period (2024-2030). We applied the model to 53 countries receiving PEPFAR support. Results From 2004-2022 the PEPFAR program averted 2.8 million new child HIV infections, 1.5 million child HIV-related deaths and prevented 8.2 million children from becoming AIDS orphans. A continuation of PEPFAR at its current level through 2030 would avert one million new child HIV infections, 460,000 child HIV-related deaths and 2.8 million AIDS orphans. Discussion The PEPFAR program has been crucial to the success that has been achieved to date in the global fight against AIDS. That success has created an obligation. Continuation of PEPFAR is critical to the effort to achieve the end of AIDS in the coming years. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Support for the development of the Goals model was provided by the Bill & Melinda Gates Foundation (OPP1191665) and UNAIDS (PO#202912623). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors