The President's Emergency Plan for AIDS Relief — Is the Emergency Over?

Abstract

In his 2003 State of the Union Address, President George W. Bush asked Congress to commit $15 billion over the next 5 years for the President's Emergency Plan for AIDS Relief (PEPFAR) to combat the global epidemic of human immunodeficiency virus (HIV) infection. Thus was launched one of the largest international health-assistance programs in history. PEPFAR has since been both condemned as unilateral, paternalistic, narrowly focused, and distorted by a political agenda and lauded as groundbreaking, visionary, effective, and responsible for saving hundreds of thousands of lives. This year, Congress has had to consider the reauthorization of the program. On July 16, the Senate approved legislation that would increase the funding to $48 billion for the next 5 years, sending the measure into conference committee. Thus, this seems an appropriate time to examine PEPFAR's achievements, limitations, and lessons for the future.