President's Emergency Plan for AIDS Relief

The President's Emergency Plan For AIDS Relief (PEPFAR/Emergency Plan) is a United States governmental initiative to address the global HIV/AIDS epidemic and help save the lives of those suffering from the disease, primarily in Africa.

The program has provided antiretroviral treatment (ART) to over 7.7 million HIV-infected people in resource-limited settings and supported HIV testing and counseling (HTC) for more than 56.7 million people as of 2014. PEPFAR increased the number of Africans receiving ART from 50,000 at the start of the initiative in 2004. PEPFAR has been called the largest health initiative ever initiated by one country to address a disease. The budget presented for the fiscal year 2016 included a request for $1.11 billion for PEPFAR as well as contributions from global organizations such as UNAIDS and private donors.

The massive funding increases have made anti-retrovirals widely available, saving millions of lives. Critics contend that spending a portion of funding on abstinence-until-marriage programs is unjust while others feel that foreign aid is generally inefficient.

In 1998, when George W. Bush discussed running for president with Condoleezza Rice, she suggested that, if he won, Africa should be a focus in terms of foreign policy. He and his wife, Laura, also had interest in the continent and "compassionate conservatism." These thoughts and sentiments helped lead to the creation of the PEPFAR program.

The unclassified publication,The Next Wave of HIV/AIDS: Nigeria, Ethiopia, Russia, India, and China by the National Intelligence Council had been commissioned by the Bush White House in 2002 and was influential in the founding of PEPFAR. This work was significant because it discussed the mortality associated with the poorly controlled HIV pandemic across several decades and also forecast the impact of that excess mortality on U.S National Security interests.

The U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (or the Global AIDS Act) specified a series of broad and specific goals, alternately delegating authority to the President for identifying measurable outcomes in some areas, and specifying by law the quantitative benchmarks to be reached within discrete periods of time in others. The legislation also established the State Department Office of the Global AIDS Coordinator to oversee all international AIDS funding and programming.

In July 2008, PEPFAR was renewed, revised and expanded as the "Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008". The expansion more than tripled the initiative's funds, to $48 billion through 2013, including $39 billion for HIV and the global Fund, $4 billion for TB, and $5 billion for malaria.

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