Who are PEPFAR’s Beneficiaries?: Analysis of Populations Served in 2022

Introduction

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the largest initiative addressing a single disease globally, provides a range of prevention, testing, and treatment services to people living with and at risk for HIV. PEPFAR reports that it has saved 25 million lives since its inception and currently supports antiretroviral treatment and other services for millions. Its efforts aim to reach the highest burden populations and improve HIV outcomes in those who are most affected, including women and adolescent girls, men and adolescent boys, children, and people in key and other priority population groups.

To get a better understanding of PEPFAR’s beneficiaries, we analyzed PEPFAR’s Monitoring, Evaluation, and Reporting (MER) indicator data for 2022, representing data from 62 supported PEPFAR countries. We looked specifically at the demographic characteristics of those served by the program, including by sex and age, and which services they used. We also analyzed data on key populations served (defined by PEPFAR to include men who have sex with men, transgender people, sex workers, people who inject drugs, and people in prisons and other closed settings) as well as PEPFAR’s priority populations (clients of sex workers, members of military and other uniformed services, displaced persons, and mobile populations), supplementing MER data with PEPFAR expenditure data, as MER data on these populations were limited, for 2022.

Overall, in 2022, PEPFAR provided testing services to 64.1 million people, including 2.2 million who newly tested positive for HIV (See Figure 1). In addition, PEPFAR supported the provision of antiretroviral treatment (ART) to 19.9 million people in 2022, or about three-quarters of all people living with HIV in PEPFAR countries (and almost half of all those on ART globally).¹ PEPFAR newly enrolled 2.1 million on ART in 2022. The majority of people served by PEPFAR in 2022 were female, including 59% of those tested and 63% of those on ART, and most were ages 15 or older (See Figures 2 and 3). Of the 15.3 million people on ART with a documented viral load result, 14.6 million (95%) were virally suppressed (See Figure 4).

PEPFAR also provided preventive services² to 3.9 million people from key populations and 5.4 million from priority populations, and newly enrolled 1.5 million people³ on pre-exposure prophylaxis (PrEP) (See Figure 5).

More than a quarter of the 62 PEPFAR countries analyzed here have already reached global targets for epidemic control.⁴

Taken together, these data indicate that PEPFAR is reaching large shares of people with and at risk for HIV. Still, as noted below, there are some populations who lag behind, particularly younger age groups, with children less likely to have received ART or to be virally suppressed. Data on specific groups follow.

Women and Adolescent Girls

• In 2022, PEPFAR provided testing services to 38.1 million women and adolescent girls (ages 15+), 1.2 million of whom newly tested positive. Those between the ages of 15-24 accounted for the largest share of women and adolescent girls tested (37% or 14 million), followed closely by those ages 25-34 (36% or 13.7 million); this latter group accounted for the largest share newly testing positive (39% or 483,000) (See Figures 6 and 7).
• PEPFAR supported ART for 12.6 million women and adolescent girls in 2022, including 1.2 million newly enrolled on ART. Most were ages 35 or older, although among those newly enrolled, those ages 25-34 represented the largest share (See Figures 6 and 7).
• Almost all (96% or 9.4 million) women and adolescent girls on ART with a documented viral load result were virally suppressed. Their age distribution is similar to that of those enrolled on ART overall, with most ages 35 and older. Viral suppression was lowest among the youngest cohort, those ages 15-24 (See Figures 6-8).
• PEPFAR also provided ART to 732,000 HIV-positive pregnant women to help reduce the risk of mother-to-child transmission during pregnancy.
• PEPFAR newly enrolled 920,000 women and adolescent girls on PrEP to prevent HIV infection.
• Finally, 2.1 million adolescent girls and young women, ages 10-24, participated in PEPFAR’s DREAMS programming in 2022.⁵

Men and Adolescent Boys

• In 2022, PEPFAR provided HIV testing services to 17.6 million men and adolescent boys, including 826,000 who newly tested positive. Those ages 25-34 accounted for the largest share – a third – of men and adolescent boys tested (33% or 5.8 million) and of those newly testing positive (33% or approximately 274,000) (See Figures 9 and 10).
• PEPFAR supported ART for 6.6 million men and adolescent boys in 2022, including 802,000 newly enrolled on ART. Most were ages 35 or above, although, as with women, among those newly enrolled on ART, those ages 25-34 represented the largest share (See Figures 9 and 10).
• Almost all men and adolescent boys on ART with a documented viral load result were virally suppressed (95% or 4.7 million). Their age distribution is similar to that of those enrolled on ART overall, with most ages 35 and older. Viral suppression was lowest among men ages 15-24 (89%) and highest among those 45+ (96%) (See Figures 9-11).
• PEPFAR newly enrolled 531,000 men and adolescent boys on PrEP to prevent HIV infection.
• PEPFAR also reached 2 million men and boys⁶ with voluntary medical male circumcision services in 2022.

Children

• In 2022, PEPFAR provided HIV testing services to 5.5 million children (under age 15).⁷ Approximately 74,000 children newly tested positive. Children under age 5 accounted for the largest share (39% or 2.1 million) of children tested and those newly positive (40% or approximately 30,000) (See Figures 12 and 13).
• PEPFAR supported ART for approximately 658,000 children, including 80,000 (12%) newly enrolled on ART. Almost half of those newly enrolled on ART were under age 5 (See Figures 12 and 13).
• Of children on ART with a documented viral load result, most (86% or approximately 457,000) were virally suppressed. Viral suppression was lowest among children under age 5 (77%) and higher for those ages 5-9 and 10-14 (87%, respectively) (See Figure 14).
• Approximately 846,000 children born to HIV-positive pregnant women had a virologic test within the first 12 months of age. Very few infants (approximately 11,000) newly tested positive (See Figure 15).
• 7.2 million people,⁸ including children who are orphaned, living with, affected by, or at risk of becoming infected with HIV, living with caregivers who are living with HIV, or have a combination of these factors, as well as caregivers of these children, were served by PEPFAR’s orphans and vulnerable children (OVC) programs in 2022.

Key Populations

• In 2022, PEPFAR provided preventive services to 3.9 million people from key populations.⁹
• PEPFAR expenditure data indicates that in 2022, PEPFAR expenditures for key populations totaled $223 million, of which 28% or $62 million was designated for a specific key population group.¹⁰ The largest share was for services for sex workers ($28 million), followed by men who have sex with men ($19 million). Services for transgender people represented the smallest share of expenditures ($1.1 million) (See Figure 16).

Priority Populations

• In 2022, PEPFAR provided preventive services¹¹ to 5.4 million people from priority populations.¹²
• PEPFAR spending on priority populations was $101 million in 2022, of which $31 million was designated for a specific priority population group as follows: members of the military and other uniformed services ($28 million), displaced persons ($1.6 million), clients of sex workers ($708,000), and mobile populations¹³ ($697,000) (See Figure 17).¹⁴

Methods

This data note is based on KFF analysis of data from PEPFAR’s Monitoring, Evaluation, and Reporting (MER) dataset and PEPFAR’s expenditure dataset on PEPFAR’s Panorama Spotlight dashboard.  MER data classified as “Unknown age” were included in the “Overview of PEPFAR beneficiaries” section as “Age not known;” however, these data were not included in the population-specific sections since lack of information about age did not allow this data to be correctly placed by population (i.e., Women and adolescent girls 15+, children <15, etc.). MER data classified as “Coarse” (data that are not further disaggregated into detailed age groups) were included in the population-specific sections of the analysis as “Age not known.” This analysis does not include MER data classified as “Retired Age Band,” as these age bands are no longer used and accounted for very small numbers of people tested and newly testing positive. MER data for children <15 were classified in the data as “Unknown sex.” Totals were calculated for each indicator based on the guidance provided in the PEPFAR Monitoring, Evaluation, and Reporting Indicator Reference Guide. All amounts included in this analysis are rounded. Financial data were interpreted based on the guidance provided in the PEPFAR Financial Classification Reference Guide. Financial data represent the total expended resources during the 12-month 2022 fiscal year period (October 1 – September 30, 2022).