In 2003, HIV/AIDS was killing millions of people globally each year and continuing to spread rapidly in sub-Saharan Africa. In response, Congress enacted the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act, authorizing $15 billion in federal funding over five years. This program—proposed by President George W. Bush—became known as the President’s Emergency Plan for AIDS Relief (PEPFAR). Congress has since reauthorized the program four times.

Supporters of PEPFAR argued that its passage and reauthorizations would:

• “prevent seven million new AIDS infections, treat at least two million people with life-extending drugs, and provide humane care for millions of people suffering from AIDS, and for children orphaned by AIDS.” (President George W. Bush)
• “be the most justified financial expense the United States Congress has undertaken.” (Representative Jim Leach)
• ‍“facilitate[]deep partnerships with a new generation of African leaders; and … improve[]attitudes toward the United States in Africa and other regions.” (Senator Richard Lugar)
• “save the lives of tens of millions of innocent people across the globe.” (Representative Tom Lantos)
• “help ensure that terrorists are given no safe harbor in Africa.” (Representative Todd Tiahrt)
  

These projections have been borne out. The program has prevented more than 25 million HIV infections, provided lifesaving treatment to over 20 million people, dramatically reduced AIDS-related deaths, and supported millions of children orphaned or made vulnerable by the epidemic. It transformed HIV from a death sentence into a manageable chronic condition across much of Africa. It also strengthened health systems and became one of the most successful global health initiatives in history.