When I first started working for PEPFAR in 2003, I was part of the HIV prevention branch at CDC Atlanta. Much of our work was centered around encouraging testing as a prevention strategy as part of the prevention of mother-to-child transmission. At the time, some countries had palliative care options for people living with HIV/AIDS, but this and antiretroviral therapy (ART) were very limited. I joined USAID in 2005, where I was the lead technical advisor for HIV testing and counseling and worked to expand access across countries while ensuring quality and linkages to care and treatment.
I think a couple of the biggest changes I've seen are the impact of treatment for people living with HIV, and the pivot to focus on national partners and sustainability. Early in PEPFAR, we were scaling up services at an unprecedented pace, trying to get access to life-saving treatment for as many people as possible as quickly as possible. I remember when I worked closely with HTS partners in countries like Botswana, our counselors were often spending every weekend attending funerals for family and friends who had died of AIDS. To go from that era to this current one where HIV is a manageable chronic condition and so many countries are approaching epidemic control–it is amazing.
I have been fortunate to have worked on a lot of exciting things during my time with PEPFAR, but most notably I am proud of my role in the scale up of key interventions, especially HIV testing services (HTS), pre-exposure prophylaxis (PrEP), and voluntary medical male circumcision (VMMC).
My fondest memory of my work at USAID in PEPFAR was in 2008 when I had the opportunity to co-host an international workshop on HIV testing in Zambia. We brought together Mission staff, partners, and government officials from across PEPFAR countries to work on HIV testing, in particular to expand national coverage, linkages to treatment, and scale up of provider-initiated testing. I remember it fondly because it was the first workshop of its kind and it was invigorating to bring together these amazing people from many places who were committed to scaling up testing as this gateway to the cascade of HIV services. Many of the participants continue to be technical experts to this day, and I love crossing paths and seeing them still leading USAID's HIV work.
Alison Cheng is a Deputy Division Chief for the Division of Prevention, Care, and Treatment in USAID's Office of HIV/AIDS
