Fighting HIV: The Global Fund and PEPFAR

How the global response to HIV and AIDS mobilised billions of dollars, cut drug prices dramatically and saved millions of lives.

In the late 1990s and early 2000s, HIV and AIDS were devastating parts of the world, especially sub-Saharan Africa. Effective antiretroviral therapy existed, but it cost over 10,000 dollars per person per year, far out of reach for most patients in poor countries.

Falling drug prices

A turning point came around 2001, when the Indian generic company Cipla offered a triple-drug combination for about 350 dollars per patient per year. Competition from Indian generic manufacturers drove prices down further, eventually to below 100 dollars a year. This made mass treatment affordable.

The Global Fund

The Global Fund to Fight AIDS, Tuberculosis and Malaria was created in 2002 as a partnership of governments, civil society, the private sector and affected communities. It funds programmes proposed by countries and has become one of the largest financiers of programmes against these three diseases.

PEPFAR

In 2003, the United States launched the President’s Emergency Plan for AIDS Relief, or PEPFAR. It became the largest commitment by any nation to address a single disease, funding treatment, prevention and testing in many countries. It is widely credited with saving tens of millions of lives. Its funding and operations were disrupted during the 2025 U.S. aid cuts.

Results

The number of people receiving antiretroviral therapy rose from a few hundred thousand in poor countries to around 30 million worldwide.
AIDS-related deaths fell by more than half from their peak in the mid-2000s.
Mother-to-child transmission dropped sharply.

Economics of treatment

Treatment keeps people working and caring for families.
It reduces transmission, since people with suppressed viral loads do not transmit HIV sexually.
New long-acting prevention drugs could be transformative, if prices are affordable.

India’s experience

India’s National AIDS Control Programme and free antiretroviral therapy helped reduce new infections substantially from their peak.

The price that changed everything

In 2000, treating one patient cost more than a typical family's income for many years. By the mid-2000s, generic competition brought the cost to a few hundred dollars. A mother in a rural clinic who would have died could now live to raise her children.

Thinking HIV is no longer a problem

Around 40 million people live with HIV, and hundreds of thousands still die each year. Funding cuts threaten progress.

Key takeaways

Generic drugs from Indian companies cut HIV treatment costs from over 10,000 dollars to under 100 dollars a year.
The Global Fund (2002) and PEPFAR (2003) financed mass treatment.
AIDS deaths fell by more than half from their peak.
Funding cuts in 2025 threatened progress.