The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) remains the largest global initiative aimed at combating a single disease. As it shifts focus towards long-term sustainability, equity has emerged as a central element in its strategy. This commitment to ensuring equitable health opportunities is critical, yet disparities in access and outcomes related to HIV persist across different populations. These challenges have become even more pressing amid financial pressures, a shrinking civil society space, and declining human rights conditions.
A recent analysis, based on Population-based HIV Impact Assessment (PHIA) surveys from 15 PEPFAR-supported countries, explored the differences in HIV-related outcomes across key demographic groups such as urban versus rural residents, wealth levels, gender, and age. The study examined three key HIV outcomes: knowledge of HIV status, access to antiretroviral treatment (ART), and viral suppression rates. Data trends were also analyzed over time in six countries with follow-up surveys.
The findings highlight that in many cases, people in rural areas had better HIV treatment outcomes, particularly in terms of viral suppression, compared to their urban counterparts. For instance, in seven countries, viral suppression rates in rural areas were higher than in urban areas, although the differences were generally modest. In terms of income, while wealthier individuals generally experienced better HIV outcomes, in some countries, poorer individuals outperformed wealthier ones in areas like treatment access and viral suppression. Gender disparities remain significant, with men consistently showing poorer outcomes than women in all 15 countries studied, across all three HIV-related metrics. Furthermore, younger people, especially adolescents, showed the worst HIV outcomes across the board.
Overall, while significant progress has been made in improving HIV outcomes across all groups, disparities persist. These findings suggest areas where PEPFAR can direct further efforts, focusing on narrowing equity gaps, particularly for men, younger people, and urban populations, where disparities remain most pronounced.
The analysis underscores the importance of addressing inequities to enhance the effectiveness of the global HIV response. By identifying successes and ongoing challenges, policymakers and program implementers can refine strategies to achieve better health outcomes for all.