I joined USAID's Office of HIV/AIDS in late 2009 and over the past 13 years have had the opportunity to support USAID and PEPFAR in a variety of roles. Before the rollout of PEPFAR, I personally witnessed the horrors of the unchecked HIV epidemic up close. During my pediatric training, I worked with a well-intended physician in La Romana, Dominican Republic. She was treating children out of her car trunk by splitting up adult antiretroviral pills. Children were dying by the thousands. She was doing what she could for the youngest in her town. There were few available pediatric formulations at that time, even in much of the Western Hemisphere. She was the only hope for these children. Without medication, half would die before their second birthday.
Even in the early days of PEPFAR, this began to change. As I completed my residency, Texas-based Baylor College of Medicine was hiring pediatricians to live and work in Africa. I joined the medical school faculty and, over the next several years, practiced HIV medicine in Eswatini and Botswana, seeing hundreds of families and writing thousands of prescriptions for antiretroviral drugs. I watched skeletal, bedbound children become plump and playful. Parents, seeing that HIV was not a death sentence, began to seek testing for themselves and other family members. Deaths in hospital wards begin to decrease. Mothers increasingly started HIV medicines during pregnancy and increasingly gave birth to HIV-free babies. The transformation just in a few years, thanks to PEPFAR and other collaborating donors, was incredible.
Today, twenty years later, more than 20 million people on life-saving antiretroviral drugs. PEPFAR, among the most important manifestations of American leadership and goodwill ever, exists to ensure that children get to live, thrive, and achieve. They deserve no less, and those of us who dedicate our careers to helping PEPFAR succeed are both honored and fortunate to be part of it.
Now, thanks to PEPFAR’s success, epidemic control is within reach. Today, we continue to build upon hard-earned progress knowing that, with existing tools, we can control this devastating epidemic.
My grandfather, a WWII veteran, was one of only two recipients of the “Gold Pin of Honor,” given to him by Germany nearly fifty years after the first pin had been awarded. As he was battling brain cancer, Grandaddy took me up to his office, gave me the pin, and said, “Thank you for being engaged out in the world.”
When I ask myself how I can honor my grandfather’s legacy, there are very few things that could make me prouder than PEPFAR, and being part of it. My fondest PEPFAR memory is that moment I shared with Granddaddy and being reminded that every generation has to step up in one way or another.
To be sure, PEPFAR has changed over the last 20 years. This is due to a simple, undeniable fact: The world has changed because of PEPFAR.
Ryan is a Deputy Division Chief in the Division of Prevention, Care, and Treatment and a Medical Officer at the USAID Office of HIV/AIDS
