This story was written by Ellen Langhans, USAID's Office of HIV/AIDS Communications Branch Chief, and was originally appeared as a blog on Medium.

Violet Zulu, from Lilongwe, Malawi, was 11 years old in 2008 when she started refusing the medicine her mother gave her every day. “I was taking my medication for a long time and not seeing results. I was tired and needed a break,” she said. Her mother insisted she take the medicine, and when Violet refused again, her mother sat her down and told her why she needed to comply: Violet had HIV.

The medicine Violet needed to take every day is called antiretroviral therapy (ART) which, if taken as prescribed, suppresses the HIV virus so that it is no longer detectable in the body. ART helps people with HIV live long, healthy lives and also reduces the risk of HIV transmission.

After learning her status, Violet didn’t go to school for a week because she was too upset. She eventually met with a counselor at a hospital who explained the modes of HIV transmission – Violet was born with the virus – and how critical it is to take her medication every day.

“After I learned my status, the only time I was happy to take my medication was when I learned about the importance of it,” Violet said.

Violet Zulu. Credit: MK Creative Images
Violet Zulu.
Credit: MK Creative Images

In 1987, the U.S. Food and Drug Administration approved the first antiretroviral drug for treatment of HIV/AIDS and in 1995, what is now known as ART was introduced. It wasn’t until 2004, however, that ART was introduced to sub-Saharan Africa thanks to the President’s Emergency Plan for AIDS Relief (PEPFAR). By that time, HIV and AIDS had decimated populations of many countries.

Thereza Nyirongo, now 68, vividly remembers the year 2006. She was so sick that her family wasn’t sure if she was going to survive as they moved from one hospital to another trying to figure out what was wrong.

“There were many of us who were looking to be tested. Some of my friends were going back to think about it, but I chose to stay, get tested, and be helped with medicine. They asked me if I had made up my mind to be tested; I told them that I was ready and would not run away from my results like some of my friends were doing. When my results came out, they asked me three times if I was ready. Then I told the doctors that I want to hear the next steps regarding my life because I want to get help,” said Thereza.

Thereza tells her story. Credit: Ellen Langhans/USAID
Thereza tells her story.
Credit: Ellen Langhans/USAID

Thereza says she was happy to learn of her status, because “the problem in my body was found and I would get help.”

She still gets her medication from the same clinic where she began treatment – the PEPFAR-supported Area 25 Health Centre’s ART clinic service delivery, run by Partners in Health in Lilongwe. Out of more than 20,000 people that the ART clinic has treated to date, Thereza was patient 39 and has been on ART for 17 years.

Violet and Thereza are two of millions of people whose lives have been saved through PEPFAR. As of 2022, approximately 20 million people living with HIV, in 54 countries, received PEPFAR-supported ART.

According to the U.S. Centers for Disease Control and Prevention, that number represents a 300-fold increase from 66,550 in 2004. Now in its 20th year, PEPFAR – the largest commitment by any nation to address a single disease in the world – has helped save more than 25 million lives.

Thanks to services from PEPFAR, through USAID, both Violet and Thereza live full and healthy lives. Thereza is able to work to help support her family, and is also a volunteer at a nearby clinic where she explains HIV to people and advises them to get tested. “I share the story of how sick I got, my testing, and how I am now able to do my work at the manure-making site. I tell them that I have never been admitted to the hospital because I accepted my status and I am on drugs, and that they should accept and get help,” said Thereza.

Violet poses with her hands in fist, like she is “fighting” HIV
Violet in an antiretroviral drug (ARV) campaign. “With ARV, I can achieve my vision if I take the medicine regularly.”
Credit: MK Creative Images

On ART for 15 years, Violet has grown into a mentor with Baylor College of Medicine Children’s Foundation Malawi for adolescents living with HIV. She is also a social media influencer who encourages others living with HIV to take care of themselves and seek health services. After someone she trusted disclosed her status to people at school, Violet became depressed but eventually thought, “I wonder if anyone else is going through this and if there is a better way to share my story so that people should learn something. When you share your story, you give courage to others.”

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