A model for other health challenges

The investments made in health have enabled a trained force of health workers to pivot to outbreak response and HIV labs to add testing and genomic sequencing to discover how the viruses are evolving.

"The benefits were seen beyond HIV, because you had an infrastructure or capability in managing infectious diseases," Lewin said. And when other outbreaks strike, progress on HIV can continue in spite of upheaval. In 2020, despite COVID-19, countries receiving PEPFAR support were still able to make gains in treating HIV and lowering patients' viral loads, according to a study from the U.S. Centers for Disease Control and Prevention. "Countries which had the PEPFAR programs did better in COVID, which I think is just absolutely extraordinary," Lewin said.

PEPFAR should continue focusing on HIV since the virus still has a huge effect on global health, El-Sadr said — but the investments in PEPFAR can give countries a leg up on other challenges. The same tools that help fight HIV — health workers, labs and more — can also be used to respond to other crises, whether they are non-communicable diseases, the next pandemic, antimicrobial resistance or any other health threat that emerges.

During Uganda's recent Ebola outbreak, Nkengasong advised officials to use the health-care workers, clinics and labs supported by PEPFAR to respond to the hemorrhagic fever. It's a good idea for health workers who are normally focused on HIV to respond quickly to other outbreaks, like cholera, Ebola, and mpox, so that there are as few disruptions as possible to HIV care, he said. "Until and unless you get rid of those [other health concerns], there's no way that we get back to the business of fighting HIV/AIDS."

Suppressing other outbreaks quickly means that resources are less likely to be diverted from pressing challenges like HIV in the long run. And by addressing existing health issues now, countries will be in a stronger position to face whatever other crises arise, Nkengasong said.