The United States President's Emergency Plan For AIDS Relief (PEPFAR) is the

global health funding by the United States The United States is the largest donor of multilateral global health funds. According to the Office of Management and Budget, the U.S. government contributes <1% of the federal budget for

HIV/AIDS The HIV, human immunodeficiency virus (HIV) is a retrovirus that attacks the immune system. Without treatment, it can lead to a spectrum of conditions including acquired immunodeficiency syndrome (AIDS). It is a Preventive healthcare, pr ...

epidemic An epidemic (from Greek ἐπί ''epi'' "upon or above" and δῆμος ''demos'' "people") is the rapid spread of disease to a large number of hosts in a given population within a short period of time. For example, in meningococcal infection ...

and help save the lives of those suffering from the disease. As of 2023, PEPFAR has saved over 25 million lives, primarily in

sub-Saharan Africa Sub-Saharan Africa is the area and regions of the continent of Africa that lie south of the Sahara. These include Central Africa, East Africa, Southern Africa, and West Africa. Geopolitically, in addition to the list of sovereign states and ...

. Launched by U.S. President

George W. Bush George Walker Bush (born July 6, 1946) is an American politician and businessman who was the 43rd president of the United States from 2001 to 2009. A member of the Bush family and the Republican Party (United States), Republican Party, he i ...

in 2003, as of August 2024, PEPFAR has provided cumulative funding of $120 billion for HIV/AIDS treatment, prevention, and research since its inception, making it the largest commitment by any nation focused on a single disease in history. PEPFAR is implemented by a combination of U.S. government agencies in over 50 countries and overseen by the Global AIDS Coordinator at the

United States Department of State The United States Department of State (DOS), or simply the State Department, is an United States federal executive departments, executive department of the U.S. federal government responsible for the country's foreign policy of the United State ...

. The PEPFAR program has in recent years been criticized by members of the Republican Party who have sought to block its re-authorization. Republicans alleged that the program promoted abortion. In 2025, the second administration of

President Donald Trump Donald John Trump (born June 14, 1946) is an American politician, media personality, and businessman who is the 47th president of the United States. A member of the Republican Party (United States), Republican Party, he served as the 45 ...

put

USAID The United States Agency for International Development (USAID) is an agency of the United States government that has been responsible for administering civilian United States foreign aid, foreign aid and development assistance. Established in 19 ...

on a 90-day freeze which involved putting PEPFAR on halt and taking its computer systems offline. On January 28, 2025, the Trump administration granted a waiver for essential medicines and medical services which included HIV medicines. However, on the ground, PEPFAR did not seem to restart.

History

PEPFAR began with President

and his wife,

Laura Bush Laura Lane Welch Bush (née Welch; born November 4, 1946) is an American educator who was the first lady of the United States from 2001 to 2009 as the wife of George W. Bush, the 43rd president of the United States. Bush was previously the fir ...

, and their interests in AIDS prevention,

Africa Africa is the world's second-largest and second-most populous continent after Asia. At about 30.3 million km2 (11.7 million square miles) including adjacent islands, it covers 20% of Earth's land area and 6% of its total surfac ...

, and what Bush termed “ compassionate conservatism.” According to his 2010 memoir, '' Decision Points'', the two of them developed a serious interest in improving the fate of the people of Africa after reading Alex Haley’s ''

Roots A root is the part of a plant, generally underground, that anchors the plant body, and absorbs and stores water and nutrients. Root or roots may also refer to: Art, entertainment, and media * ''The Root'' (magazine), an online magazine focusin ...

'', and visiting

The Gambia The Gambia, officially the Republic of The Gambia, is a country in West Africa. Geographically, The Gambia is the List of African countries by area, smallest country in continental Africa; it is surrounded by Senegal on all sides except for ...

in 1990. In 1998, while pondering a run for the U.S. presidency, he discussed Africa with

Condoleezza Rice Condoleezza "Condi" Rice ( ; born November 14, 1954) is an American diplomat and political scientist serving since 2020 as the 8th director of Stanford University's Hoover Institution. A member of the Republican Party, she previously served ...

, his future secretary of state; she said that, if elected, working more closely with countries on that continent should be a significant part of his foreign policy. She also told him that HIV/AIDS was a central problem in Africa but that the United States was spending only $500 million per year on global AIDS, with the money spread across six federal agencies, without a clear strategy for curbing the epidemic. 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. PEPFAR continues to be a cornerstone of U.S. global health efforts. On April 4, 2014, Ambassador Deborah L. Birx was sworn in as

United States Global AIDS Coordinator The global AIDS coordinator at the United States Department of State is the official responsible for overseeing U.S.-sponsored humanitarian aid programs to combat the AIDS epidemic around the world. The global AIDS coordinator holds the rank of ...

. She held the position until January 2021 when Angeli Achrekar filled the Acting role, from being Principal Deputy. In May 2022, Dr. John N. Nkengasong was confirmed by the U.S. Senate as the U.S. Global AIDS Coordinator and was officially sworn in on June 13, 2022. On August 1, 2023, Ambassador Nkengasong joined U.S. Secretary of State

Antony Blinken Antony John Blinken (born April 16, 1962) is an American lawyer and diplomat who served as the 71st United States secretary of state from 2021 to 2025. He previously served as Deputy National Security Advisor, deputy national security advisor ...

to launch the State Department’s Bureau of Global Health Security and Diplomacy, which he led until the

second cabinet of Donald Trump Donald Trump assumed office as the 47th president of the United States on Second inauguration of Donald Trump, January20, 2025. The president has the legal authority to nominate members of his Cabinet of the United States, cabinet to the United ...

assumed office on January20, 2025. In December 2014, PEPFAR announced a program PEPFAR 3.0 focusing on Sustainable Control of the AIDS epidemic. This program was designed to address the UNAIDS "90-90-90" global goal: 90 percent of people with HIV diagnosed, 90 percent of them on ART and 90 percent of them virally suppressed by the year 2020.

PEPFAR under second Trump presidency

90-day freeze at USAID

On January 20, 2025, President Trump signed

Executive Order 14155 Executive Order 14155, titled "Withdrawing the United States from the World Health Organization", is an executive order signed by United States president Donald Trump on January 20, 2025, during the first day of his second presidential term. Th ...

initiating the United States’ withdrawal from the

World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...

. This happened along with

Executive Order 14169 Executive Order 14169, titled "Reevaluating and Realigning United States Foreign Aid", is an executive order signed by U.S. president Donald Trump hours after he took office January 20, 2025, ordering a 90-day pause on all U.S. foreign developme ...

to freeze

foreign aid In international relations, aid (also known as international aid, overseas aid, foreign aid, economic aid or foreign assistance) is – from the perspective of governments – a voluntary transfer of resources from one country to another. The ...

, impacting global health programs including PEPFAR. Subsequently, the U.S. State Department announced a comprehensive freeze on new funding for most foreign aid programs worldwide, excluding emergency food aid and military assistance to Israel and Egypt. This suspension affected billions of dollars allocated for health, education, development, and other aid initiatives, with no exemptions for programs like PEPFAR. Humanitarian organizations were alarmed.

Waiver for PEPFAR, in practice

On January 28, 2025 the Trump administration granted a waiver for essential medicines and medical services, temporarily restoring a global HIV treatment program that they had suspended the previous week. U.S. Secretary of State Marco Rubio announced the waiver, which appeared to permit the distribution of HIV medications.Senator Bill Cassidy (R-Louisiana), who is a medical doctor, posted on February 4, 2025 that money for PEPFAR does not seem to be flowing.“Crucial aid sits in warehouses worldwide as USAID employees are told to stop working,”
Suzy Khimm, Feb 4, 2025. Through mid-April 2025, the country of Zambia had not had its PEPFAR program restarted. President Trump’s task force “Department of Government Efficiency (DOGE)” had engaged in such actions as large staff layoffs and the seizure of finance systems, which essentially led to the collapse of

by April. The disruption to PEPFAR went further than was suggested in

Project 2025 Project 2025 (also known as the 2025 Presidential Transition Project) is a political initiative to reshape the federal government of the United States and consolidate executive power in favor of right-wing policies. The plan was published in ...

, which had praised PEPFAR as “America’s most successful aid program.”

Human and political consequences

The International AIDS Society (IAS) warned that the immediate halting of funding to PEPFAR, including a stop-work order for existing grants and contracts, threatened millions of lives. More than 20 million people living with HIV globally, including 550,000 children under 15, depended on daily services provided with support from the PEPFAR program. These actions led to widespread concern about the future of HIV/AIDS programs and the potential reversal of progress made in combating the epidemic. Similar to foreign aid in general, the George W. Bush Presidential Center makes the point that as the U.S. moves out, China may move in. And therefore, the United States may lose influence. In an early April article in ''

The Lancet ''The Lancet'' is a weekly peer-reviewed general medical journal, founded in England in 1823. It is one of the world's highest-impact academic journals and also one of the oldest medical journals still in publication. The journal publishes ...

'', a team of experts proposed a 5-year transition plan of moving from PEPFAR to medication provided by the national health services of the nations most affected by AIDS. Brooke Nichols, a health economist and infectious disease modeler at Boston University, has created a tracking tool to address the lack of data in this area. According to her model, as of May 2025, an estimated 96,000 adults and 200,000 children have died due to reductions in government funding for aid and support organizations.

Focus countries

When PEPFAR was signed into law 15 resource-limited countries with high HIV/AIDS prevalence rates were designated to receive the majority of the funding. The 15 "focus countries" were

Botswana Botswana, officially the Republic of Botswana, is a landlocked country in Southern Africa. Botswana is topographically flat, with approximately 70 percent of its territory part of the Kalahari Desert. It is bordered by South Africa to the sou ...

Côte d'Ivoire Ivory Coast, also known as Côte d'Ivoire and officially the Republic of Côte d'Ivoire, is a country on the southern coast of West Africa. Its capital city of Yamoussoukro is located in the centre of the country, while its largest city and ...

Ethiopia Ethiopia, officially the Federal Democratic Republic of Ethiopia, is a landlocked country located in the Horn of Africa region of East Africa. It shares borders with Eritrea to the north, Djibouti to the northeast, Somalia to the east, Ken ...

Guyana Guyana, officially the Co-operative Republic of Guyana, is a country on the northern coast of South America, part of the historic British West Indies. entry "Guyana" Georgetown, Guyana, Georgetown is the capital of Guyana and is also the co ...

Haiti Haiti, officially the Republic of Haiti, is a country on the island of Hispaniola in the Caribbean Sea, east of Cuba and Jamaica, and south of the Bahamas. It occupies the western three-eighths of the island, which it shares with the Dominican ...

Kenya Kenya, officially the Republic of Kenya, is a country located in East Africa. With an estimated population of more than 52.4 million as of mid-2024, Kenya is the 27th-most-populous country in the world and the 7th most populous in Africa. ...

Mozambique Mozambique, officially the Republic of Mozambique, is a country located in Southeast Africa bordered by the Indian Ocean to the east, Tanzania to the north, Malawi and Zambia to the northwest, Zimbabwe to the west, and Eswatini and South Afr ...

Namibia Namibia, officially the Republic of Namibia, is a country on the west coast of Southern Africa. Its borders include the Atlantic Ocean to the west, Angola and Zambia to the north, Botswana to the east and South Africa to the south; in the no ...

Nigeria Nigeria, officially the Federal Republic of Nigeria, is a country in West Africa. It is situated between the Sahel to the north and the Gulf of Guinea in the Atlantic Ocean to the south. It covers an area of . With Demographics of Nigeria, ...

Rwanda Rwanda, officially the Republic of Rwanda, is a landlocked country in the Great Rift Valley of East Africa, where the African Great Lakes region and Southeast Africa converge. Located a few degrees south of the Equator, Rwanda is bordered by ...

South Africa South Africa, officially the Republic of South Africa (RSA), is the Southern Africa, southernmost country in Africa. Its Provinces of South Africa, nine provinces are bounded to the south by of coastline that stretches along the Atlantic O ...

Tanzania Tanzania, officially the United Republic of Tanzania, is a country in East Africa within the African Great Lakes region. It is bordered by Uganda to the northwest; Kenya to the northeast; the Indian Ocean to the east; Mozambique and Malawi to t ...

Uganda Uganda, officially the Republic of Uganda, is a landlocked country in East Africa. It is bordered to the east by Kenya, to the north by South Sudan, to the west by the Democratic Republic of the Congo, to the south-west by Rwanda, and to the ...

Vietnam Vietnam, officially the Socialist Republic of Vietnam (SRV), is a country at the eastern edge of mainland Southeast Asia, with an area of about and a population of over 100 million, making it the world's List of countries and depende ...

, and

Zambia Zambia, officially the Republic of Zambia, is a landlocked country at the crossroads of Central Africa, Central, Southern Africa, Southern and East Africa. It is typically referred to being in South-Central Africa or Southern Africa. It is bor ...

. Most of the $15 billion for the program was to be spent on these focus countries, $4 billion was allocated for programs elsewhere, and for HIV/AIDS research (the other $1 billion was contributed to the Global Fund). With the reauthorization of PEPFAR in 2008 there was a shift away from the "focus country" approach by authorizing the development of a Partnership Framework model for regions and countries, with the aim of ensuring long-term sustainability and country leadership. Through bilaterally-funded programs, PEPFAR works in partnership with host nations to support treatment, prevention and care for millions of people in more than 85 countries. Partnership Frameworks provide a 5-year joint strategic framework for cooperation between the U.S. Government, the partner government, and other partners to combat HIV/AIDS in the host country through service delivery, policy reform, and coordinated financial commitments.See th
PEPFAR World Wide Activities Map
an
PEPFAR Dashboard

Implementing agencies

Office of the Global AIDS Coordinator

Housed in the Department of State, the Office of the Global AIDS Coordinator oversees the implementation of PEPFAR and ensures coordination among the various agencies involved in the U.S global response to HIV/AIDS. United States Ambassadors from the State Department provide essential leadership to interagency HIV/AIDS teams and engage in policy discussions with host-country leaders.

United States Agency for International Development

An independent federal agency, the

United States Agency for International Development The United States Agency for International Development (USAID) is an agency of the United States government that has been responsible for administering civilian foreign aid and development assistance. Established in 1961 and reorganized in 1998 ...

receives overall foreign policy guidance from the Secretary of State and is the agency primarily responsible for administering civilian foreign aid. USAID supports the implementation of PEPFAR programs in nearly 100 countries, through direct in-country presence in 50 countries and through seven other regional programs.

United States Department of Health and Human Services

Under PEPFAR, the

United States Department of Health and Human Services The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the US federal government created to protect the health of the US people and providing essential human services. Its motto is ...

(HHS) implements PEPFAR-funded prevention, treatment and care programs through the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), and Substance Abuse and Mental Health Services Administration (SAMHSA). The Office of Global Health Affairs within HHS coordinates all of the HHS agencies to be sure PEPFAR resources are being used effectively.

Centers for Disease Control and Prevention

As part of the Department of Health and Human Services, the

Centers for Disease Control and Prevention The Centers for Disease Control and Prevention (CDC) is the National public health institutes, national public health agency of the United States. It is a Federal agencies of the United States, United States federal agency under the United S ...

uses PEPFAR funding to implement its Global AIDS Program (GAP). GAP works with highly trained physicians, epidemiologists, public health advisers, behavioral scientists, and laboratory scientists in 29 countries, who are part of USG teams implementing PEPFAR. Through partnerships with host governments, Ministries of Health, NGOs, international organizations, U.S.-based universities, and the private sector, GAP assists with HIV prevention, treatment, and care; laboratory capacity building; surveillance; monitoring and evaluation; and public health evaluation research.

United States Department of Defense

The

United States Department of Defense The United States Department of Defense (DoD, USDOD, or DOD) is an United States federal executive departments, executive department of the federal government of the United States, U.S. federal government charged with coordinating and superv ...

(DoD) implements PEPFAR programs by supporting HIV/AIDS prevention, treatment, care, strategic information, human capacity development and program/policy development in host military and civilian communities. The DoD HIV/AIDS Prevention Program (DHAPP) is the DoD Executive Agent for the technical assistance, management, and administrative support of the global HIV/AIDS prevention, care and treatment for foreign militaries.

United States Department of Commerce

The

United States Department of Commerce The United States Department of Commerce (DOC) is an executive department of the U.S. federal government. It is responsible for gathering data for business and governmental decision making, establishing industrial standards, catalyzing econ ...

(DoC) provides support for PEPFAR by furthering private sector engagement through public-private partnerships. Housed within DoC, the U.S. Census Bureau assists with data management and analysis, survey support, estimating infections averted and supporting mapping of country-level activities.

United States Department of Labor

The

United States Department of Labor The United States Department of Labor (DOL) is one of the executive departments of the U.S. federal government. It is responsible for the administration of federal laws governing occupational safety and health, wage and hour standards, unemp ...

(DoL) implements PEPFAR workplace-targeted projects that focus on the prevention and reduction of HIV/AIDS-related stigma and discrimination. DoL programs (in over 23 countries) consist of three main components: increasing knowledge about HIV/AIDS, implementing workplace policies to reduce stigma and discrimination and building capacity of employers to provide support services.

Peace Corps

With programs in 73 countries, the Peace Corps is heavily involved in the fight against HIV/AIDS.

Peace Corps The Peace Corps is an Independent agency of the U.S. government, independent agency and program of the United States government that trains and deploys volunteers to communities in partner countries around the world. It was established in Marc ...

volunteers provide long-term capacity development support to nongovernmental, community-based, and faith-based organizations as they provide holistic support to people living with and affected by HIV/AIDS.

Programs

The U.S. President's Emergency Plan for AIDS Relief: Five-Year Strategy report from 2009 outlines the PEPFAR strategy and programs for the fiscal years 2010-2014.

Prevention

To slow the spread of the epidemic, PEPFAR supports a variety of prevention programs: the ABC approach (Abstain, Be faithful, and correct and consistent use of Condoms); prevention of mother to child transmission (PMTCT) interventions; and programs focusing on blood safety, injection safety, secondary prevention ("prevention with positives"), counseling and education. Initially, a recommended 20% of the PEPFAR budget was to be spent on prevention, with the remaining 80% going to care and treatment, laboratory support, antiretroviral drugs, TB/HIV services, support for orphans and vulnerable children (OVC), infrastructure, training, and other related services. Of the 20% spent on prevention, one third, or 6.7% of the total, was to be spent on abstinence-until-marriage programs in fiscal years 2006 through 2008, a controversial requirement (see below). The other two thirds was allotted for the widespread array of prevention interventions described above, including counseling, education, injection safety, blood safety and condoms. The 2008 reauthorization of PEPFAR eliminated the 20% recommendation for prevention efforts, including the requirement for abstinence programs."International HIV/AIDS, Tuberculosis, and Malaria: Key Changes to U.S. Programs and Funding"
(PDF). Congressional Research Service, August 25, 2008.

Treatment

In addition to providing

antiretroviral therapy The management of HIV/AIDS normally includes the use of multiple antiretroviral drugs as a strategy to control HIV infection. There are several classes of antiretroviral agents that act on different stages of the HIV life-cycle. The use of mul ...

(ART), PEPFAR supports prevention and treatment of opportunistic infections, as well as services to prevent and treat malaria, tuberculosis, waterborne illness, and other acute infections. PEPFAR supports training and salaries for personnel (including clinicians, laboratorians, pharmacists, counselors, medical records staff, outreach workers, peer educators, etc.), renovation and refurbishment of health care facilities, updated laboratory equipment and distribution systems, logistics and management for drugs and other commodities. This is intended to ensure the sustainability of PEPFAR services in host countries, enabling long-term management of HIV/AIDS. PEPFAR-supported care and treatment services are implemented by a wide array of U.S.-based and international groups and agencies. Among the largest "Track 1.0" (treatment) partners are Harvard University, Columbia University's International Center for AIDS Care & Treatment Programs (ICAP), the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), and the AIDSRelief consortium of Catholic Relief Services.

Care

For those who have already been infected with HIV/AIDS, PEPFAR provides HIV

counseling Counseling is the professional guidance of the individual by utilizing psychological methods especially in collecting case history data, using various techniques of the personal interview, and testing interests and aptitudes. This is a list of c ...

, resources for maintaining financial stability, etc. Special care is given to orphans and vulnerable children (OVCs) and services are provided that meet the unique needs of women and girls, including victims of sex trafficking, rape, abuse, and exploitation (see fact sheet o
Gender and HIV/AIDS
. Finally, the Emergency Plan works closely with country leaders, military groups, faith-based organizations, etc. in an attempt to eliminate stigma.

Health Systems Strengthening

PEPFAR has directly and indirectly contributed to the health systems strengthening of recipient countries including improving laboratory capacity as well as improving monitoring and evaluation including introduction of the electronic medical record systems. Another area of health system strengthening that PEPFAR has contributed to is its ability to increase the pandemic response to other infectious diseases such as

COVID-19 Coronavirus disease 2019 (COVID-19) is a contagious disease caused by the coronavirus SARS-CoV-2. In January 2020, the disease spread worldwide, resulting in the COVID-19 pandemic. The symptoms of COVID‑19 can vary but often include fever ...

. Research by Anand Reddi and colleagues has documented the effectiveness and sustainability of PEPFAR programs by emphasizing the need for integrated approaches to HIV care that can strengthen overall health systems in resource limited settings.

Antiretroviral local manufacturing

The U.S. government is supporting African production of antiretrovirals (ARVs) to address the continent's HIV epidemic. In July 2024, PEPFAR plans to expand its purchase of ARVs from local suppliers to serve 2 million African patients.

Results

The results of the program include: * As of December 2024, PEPFAR has saved 26 million lives verses 25 million lives saved in 2023. * As of September 30, 2024, PEPFAR supported antiretroviral treatment for 20.6 million people worldwide including 566,000 children verses the 20.47 million people worldwide on treatment in 2023. * In 2024, PEPFAR supported 2.5 million people newly enrolled on PrEP to prevent HIV infection. IN 2023, PEPFAR supported 1.95 million people on antiretroviral

pre-exposure prophylaxis Pre-exposure prophylaxis (PrEP), is the use of medications to prevent the spread of disease in people who have not yet been exposed to a disease-causing agent. Vaccination is the most commonly used form of pre-exposure prophylaxis; other forms of ...

. * PEPFAR supported 2.3 million adolescent girls and young women through the DREAM HIV prevention services in FY 2024 verses 2.5 million in FY2023. PrEP initiations in DREAM geographies was 475,000 clients in FY 2024. * PEPFAR directly supported 83.8 million people with HIV testing services an increase of 12 million more people since 2023 in which 71 million people were test in fiscal year 2023. * PEPFAR supported antiretroviral drug prophylaxis to prevent mother-to-child transmission (MTCT), resulting in 5.5 million babies born HIV-free. * PEPFAR directly supported 6.6 million orphans, vulnerable children and their caregivers in fiscal year 2024 a slight decrease from 2023. * PEPFAR directly supported approximately 35.1 million voluntary male circumcision procedures worldwide cumulatively from 2017 through Dec 2024 an increase of 2.7 million in FY 2024 from 2023. The U.S. is the first and largest donor to the Global Fund to Fight AIDS, Tuberculosis, and Malaria. To date, the U.S. has provided more than $7 billion to the fund. Of the estimated 8 million individuals in low- and middle-income countries who currently receive treatment, nearly 6.8 million receive support through PEPFAR bilateral programs, the Global Fund, or both. There is additional evidence in the published literature that funding towards PEPFAR vis-a-vis antiretroviral therapy also affirmed maternal and child health in addition to HIV treatment outcomes

Accountability and funding

Since the start of PEPFAR in 2003, the program has utilized multi-year appropriations. PEPFAR reports to Congress on an annual basis, providing programmatic and financial data as required by law. The Fourteenth Annual Report to Congress on the President's Emergency Plan for AIDS Relief is available on the official PEPFAR website, as are more specific reports, financial information and other information. Global AIDS funding is provided in the Foreign Operations and Labor, Health and Human Services appropriations bills, which, if the process goes smoothly, are agreed to by the House and Senate in advance of the federal fiscal year beginning October 1. The Office of the Global AIDS Coordinator (OGAC) budgets according to the allocations provided by Congress and the policy of the Administration. Funding figures by program are reported to Congress by the Office of the Global AIDS Coordinator. For FY 2013, President Obama requested $6.42 billion, including more than $4.54 billion for bilateral HIV/AIDS programs and $1.65 billion for the Global Fund. For FY 2014, President Obama requested $6.73 billion, including more than $4.88 billion for bilateral HIV/AIDS programs and $1.65 billion for the Global Fund. For FY 2024,

President Biden Joseph Robinette Biden Jr. (born November 20, 1942) is an American politician who was the 46th president of the United States from 2021 to 2025. A member of the Democratic Party, he served as the 47th vice president from 2009 to 2017 and re ...

requested at least $4.7 billion for the PEPFAR program in its annual budget request to Congress in addition to funding for the multilateral Global Fund to Fight AIDS, Tuberculosis and Malaria. PEPFAR was exempt from the Mexico City Policy.

Funding data

Annual data on the PEPFAR budget, spending by budget code, and impact estimates are available online a
PEPFAR Panorama Spotlight
Funding amounts to specific in-country implementing mechanisms and partners are only available for the year 2013 onward. In 2008, funding data was obtained by the Center for Public Integrity from PEPFAR's own information system COPRS. The data were obtained after CPI sued the U.S. State Department to gain access to the data. The data wer
analyzed by the HIV/AIDS Monitor team
at the

Center for Global Development The Center for Global Development (CGD) is a nonprofit think tank based in Washington, D.C., and London that focuses on international development. History It was founded in November 2001 by former senior U.S. official Edward W. Scott, directo ...

, who also share the full dataset.

Criticism

Controversial requirements

Some critics of PEPFAR feel that American political and social groups with moral rather than public health agendas are behind several requirements of PEPFAR, pointing to the mandates that one-third of prevention spending in 2006–2008 be directed towards

abstinence Abstinence is the practice of self-enforced restraint from indulging in bodily activities that are widely experienced as giving pleasure. Most frequently, the term refers to sexual abstinence, but it can also mean abstinence from alcohol (drug), ...

-until-marriage programs and that all funded organizations sign an anti-prostitution pledge. This pledge requires all organizations that receive PEPFAR funding to have a policy that explicitly opposes prostitution and sex trafficking which some activists compared to a

loyalty oath Loyalty is a Fixation (psychology), devotion to a country, philosophy, group, or person. Philosophers disagree on what can be an object of loyalty, as some argue that loyalty is strictly interpersonal and only another human being can be the obj ...

. A number of AIDS organizations felt such a policy would alienate their efforts to reduce HIV contraction rates among sex workers. In 2005, it was reported from United Nations' envoy leader for HIV/AIDS in Africa Stephen Lewis that the Bush administration's abstinence policy may have contributed to a shortage of condoms in Uganda. In 2013, the U.S. Supreme Court ruled that the requirement violated the First Amendment's prohibition against compelled speech in '' Agency for International Development v. Alliance for Open Society International, Inc.'' According to a study presented at the 19th Conference on Retroviruses and Opportunistic Infections in 2015, the $1.3 billion that the U.S. government spent on programs to promote abstinence in sub-Saharan Africa had no significant impact. The requirement for prevention spending was lifted with the PEPFAR reauthorization in 2008, but some critics worry that some funds could still be spent on abstinence programs. The Center for Health and Gender Equity and Health GAP outline their criticism of PEPFAR on a website known a
PEPFAR Watch
The previous 33% earmark has since been replaced by a requirement that if more than 50% of PEPFAR funds are allocated to non-abstinence promotion measures, the US Global AIDS Coordinator must report to Congress. However, the new reporting requirement continues to emphasize abstinence and fidelity to the exclusion of comprehensive approaches, such as those that include education about male and female condoms. This can cause a chilling effect for organizations receiving PEPFAR funding, who may censor their prevention activities and fall short of providing comprehensive HIV prevention services to women, men, and young people. PEPFAR also does not fund needle exchange programs, which are widely regarded as effective in preventing the spread of HIV.

Conditions

Many have argued that PEPFAR's emphasis on direct funding from the United States to African governments (bilateral programs) have been at the expense of full commitments to multilateral programs such as the Global Fund. Reasons given for this vary, but a major criticism has been that this enables the U.S. "to maximize its leverage with other countries through the funds available for distribution" since the "Global Fund and other multilateral venues do not possess the same top-down leverage as does the United States in demanding fundamental national-level reforms". However, since the inception of PEPFAR there has been a shift away from strictly bilateral funding to more multilateral programs.

Recruitment of locals

PEPFAR has been criticized for having a negative impact on the health systems in regions receiving its funding through its recruitment practices. Although Congress made attempts to limit its impact by prohibiting "topping off" salaries and limiting funding for healthcare worker training (thereby eliminating per diems as a method of augmenting salaries), PEPFAR funded programs effectively paid its local staff up to a hundred times more than that of the local healthcare structure. Rather than strictly through salaries, program staff received benefits such as housing and education subsidies. Countries, already stressed by the number of trained physicians and nurses emigrating to western nations, have seen the presence of PEPFAR programs significantly decrease the number of skilled medical professionals willing to work within the domestic healthcare infrastructure. As a result, the overall health of these communities are placed in jeopardy, but funds, physicians, and nurses are diverted to combat HIV/AIDS exclusively within the framework of PEPFAR.

Investigations

On June 15, 2011, the Department of Health and Human Services Office of Inspector General (OIG) published a report critical of the Centers for Disease Control and Prevention's (CDC's) administration of PEPFAR funds. The report read in part: "Our review found that CDC did not always monitor recipients' use of EPFARfunds in accordance with departmental and other Federal requirements.... st of the award files did not include all required documents" to demonstrate proper monitoring. On the November 19, 2012, the OIG published a report critical of the CDC Namibia Office's monitoring of the use of PEPFAR funds.

References

External links

Official

*
Office of the Global AIDS Coordinator

AIDS.gov—The U.S. Federal Domestic HIV/AIDS Resource

HIVtest.org—Find an HIV testing site near you
{{DEFAULTSORT:President's Emergency Plan For Aids Relief HIV/AIDS organizations in the United States Foreign policy of the George W. Bush administration HIV/AIDS in Africa HIV/AIDS in Ethiopia HIV/AIDS in South Africa HIV/AIDS in Uganda Government programs 2003 establishments in the United States HIV/AIDS Presidency of George W. Bush Second Trump administration controversies