PEPFAR Saved 740,000 Lives, Says New Study

Researchers from the Stanford University School of Medicine looked at the effectiveness of the U.S. President’s Emergency Plan for AIDS Relief in 9 African countries between 2004 and 2008. According to their study, PEPFAR saved the lives of 740,000 people in that period. That translates to a decline in deaths by a rate of 16% to 20% in the four years.

From US News Health:

“We were surprised and impressed to find these mortality reductions,” study author Dr. Eran Bendavid, an assistant professor of medicine at Stanford, said in a university news release.

“While many assume that foreign aid works, most evaluations of aid suggest it does not work or even causes harm,” Bendavid said. “Despite all the challenges to making aid work and to implementing HIV treatment in Africa, the benefits of the [President’s Emergency Plan for AIDS Relief] were large and measurable across many African countries.”

The program was launched in 2003 while President George W. Bush was in office with a focus on AIDS treatment and prevention in 15 countries. It was reauthorized by Congress in 2008 and now serves 31 countries.

To assess the impact of the program, Bendavid and colleagues analyzed health and survival data from more than 1.5 million adults in 27 African countries, including nine countries where the program has focused its efforts.

The authors offer some thoughts on the success of PEPFAR in reducing adult mortality.

Several possible factors may have contributed to PEPFAR’s apparent success. First, PEPFAR’s investment has been larger than any previous commitment for a single disease. Development assistance for health has grown from about 4% of US development assistance in 1999 to more than 20% by 2008, and PEPFAR accounts for a large share of this growth.1 Second, PEPFAR’s structure was unusual, with its implementation relying on experienced nongovernmental organizations and academic centers that were rewarded for reaching aggressive coverage targets. Finally, PEPFAR’s comprehensive approach to scaling up treatment programs enabled a cogent set of related activities such as antiretroviral procurement processes and supply chain management.


Our findings are also notable for the consistent association between HIV development assistance and improvements in population health when many studies of development assistance programs fail to find meaningful changes in targeted outcomes.33 – 34 Other examples where assistance was associated with its intended goals have also been in the health arena, including smallpox eradication and control of polio.35 – 36 PEPFAR’s success with HIV, however, may be the clearest demonstration of aid’s effectiveness in recent years.

Read the entire study here.