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Pioneer of US HIV/AIDS program brings hope after years of despair

  • Dr. John Nkengasong, who currently oversees the global AIDS effort, recalls the desperate scenes that played out in Africa before PEPFAR was introduced in 2004.
  • PEPFAR, launched by the Bush administration, revolutionized HIV care, saving an estimated 25 million lives in hard-hit countries.
  • Debates over funding in Congress threaten the program’s future, he said.

Through his office window, in what was then one of Africa’s few modern HIV and AIDS clinics, the man who now oversees the United States’ threatened global AIDS effort Unis was used to hearing the sound of taxis stopping throughout the day.

If he turned his head to look out the window, Dr. John Nkengasong said, he knew what he would see: another desperate family carrying a dying loved one — a man or woman already in a coma, a child skinny – and hoping to find help.

This was before the Bush administration launched the President’s Emergency Plan for AIDS Relief, known as PEPFAR, in 2004. There were virtually no effective, affordable treatments between South Africa and the Sahara, no rapid HIV tests or high-quality government laboratories. and few beds for AIDS patients.


Nkengasong spent decades working in Africa on HIV and AIDS, a career closely linked to the U.S. program that, since its introduction 20 years ago, has transformed care in some of the hardest-hit countries and saved an estimated 25 millions of lives. He spoke to The Associated Press during a funding battle in Congress that jeopardizes the future of the AIDS program.

Ambassador-at-Large John Nkengasong, new head of the Office of Global Health Security and Diplomacy at the State Department, speaks during the Concordia 2023 annual summit, September 19, 2023, in New York. Nkengasong has spent decades working in Africa on HIV and AIDS. (Riccardo Savi/Getty Images for Concordia Summit)

Opponents say HIV/AIDS funding could indirectly support overseas abortion, although the Biden administration and PEPFAR advocates say there is no evidence that is the case. After a handful of conservative lawmakers threatened for months to block funding unless restrictions were imposed, a compromise was reached in late March that extended the funding for another year.

But supporters of the program warn that without the full five-year renewal, its future remains uncertain, as the political debate over abortion and reproductive rights only becomes more combative.

Before PEPFAR, in most cases, the Nkengasong infectious disease clinic in Abidjan, Ivory Coast, could not provide any care to families. In their loved ones’ final hours, families who came there often found themselves crouching outside in the parking lot.

They surrounded “the skeleton of a human being, with a tinge of flesh on their body,” Nkengasong recalls. “They held their loved ones in their arms, giving them the best possible comfort.”

Soon the sound of wailing rose through its windows. The cries signaled another death from HIV/AIDS, one of millions in Africa in the mid-2000s.

The scene would repeat itself “almost hour by hour,” Nkengasong said. Sometimes he would get up and close the curtains, blocking out the misery of an epidemic that he could not then stem.

Two decades later, Nkengasong says, his travels to the region from his offices in Washington bring him joyful encounters with men, women and children whose lives were saved by PEPFAR, considered the largest government effort ever. carried out against a single disease.

In total, the U.S. program has spent more than $110 billion on HIV care and treatment, local medical systems and social programs aimed at stemming infection. The United States says it has saved 25 million lives in sub-Saharan Africa and other vulnerable regions, including 5.5 million children.


Nkengasong, born in Cameroon and educated in Belgium, worked in Africa in the 1990s, when the AIDS epidemic was raging virtually unchecked.

This gave rise to “a thriving coffin industry,” he said. Visiting cities in Uganda, Rwanda, Kenya and elsewhere for his work on infectious diseases, he walked streets lined with handmade coffins of all sizes.

Infectious disease clinic beds were filled with “adults lying there looking like babies, because of what HIV had done.” That ugly face,” Nkengasong remembers.

With early antiretroviral treatment costing an average of $10,000 per patient per year, it is estimated that only 50,000 HIV-infected people in sub-Saharan Africa were receiving effective treatment in the mid-to-late 1990s. This represents a total of 10 million people living with HIV and AIDS, according to the World Health Organization.


One day in the spring of 2002, while he was in his laboratory performing tests, a large American delegation suddenly arrived at the Abidjan clinic.

Health Secretary Tommy Thompson and other top U.S. health officials gathered at the facility, along with business representatives and members of faith-based organizations.

“I remember opening the door and the first person who walked in was Dr. Fauci,” Nkengasong said. Anthony Fauci, a prominent HIV researcher, was then a senior official at the US National Institutes of Health and a leader in the field of Nkengasong’s work on HIV and AIDS. “And he said, ‘John, good to see you again.’ And I was so excited.”

Unbeknownst to Nkengasong and his colleagues, National Security Advisor Condoleeza Rice and other officials had privately argued to President George W. Bush that it was in the global HIV epidemic that states -United could make a huge difference.

For the Bush administration, the epidemic represented an opportunity to do good at a time when the United States was waging war in Afghanistan, then Iraq, as well as after the attacks of September 11, 2001.

Nine months after the Americans arrived in his laboratory, “we were watching the news on CNN, it was the State of the Union address,” Nkengason remembers. “And President Bush announced the launch of PEPFAR.”

That night, the president pledged an initial $15 billion over the next five years to fight the global AIDS epidemic.

Nkengason called it an “aha moment” for himself and others fighting AIDS in the world’s most vulnerable region.


Two decades later, global AIDS deaths have fallen by almost 70% from their peak in 2004. Sub-Saharan Africa remains the most vulnerable region and is home to two-thirds of people living with HIV. But the PEPFAR program and others have strengthened health systems to fight infectious diseases, made treatment accessible to millions, and expanded support for populations most at risk, including women.

On a return trip to Abidjan, Nkengasong met a healthy 17-year-old girl, one of millions spared from infection at birth thanks to medical treatment that prevented transmission of the virus. HIV by their infected mothers.

Last summer, he visited a clinic in Namibia where HIV-infected mothers had delivered “perfectly healthy” babies thanks to treatment that saved them from infection.

“I grabbed a few babies and looked at them,” he said. As he held them, he wondered what would have happened to them without proper care.

“And they just give you this smile,” he said.

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