|Background on the President's Emergency Plan for AIDS Relief (PEPFAR)|
In his 2003 State of the Union address, President George W. Bush launched the President’s Emergency Plan for AIDS Relief (PEPFAR), pledging a groundbreaking $15 billion over five years to combat HIV/AIDS in 14 countries in Africa and the Caribbean (Vietnam was added as a 15th country in 2004). In July 2008 the law was reauthorized through 2013 for $48 million, including funding for Tuberculosis and Malaria.
PEPFAR calls for treating 2 million people, preventing 12 million new HIV infections, and provide palliative care for 12 million people. It is heralded by the international health community, AIDS activists, the American public, and many African leaders as an unprecedented U.S. government investment in the health and security of the developing world. But in an epidemic in which there are five new infections for every two people put on treatment, efforts to prevent HIV—based simultaneously on the best available evidence and on strategies to reduce stigma, discrimination and inequity—need to be redoubled to slow this pandemic.
The 2008 reauthorization made some important gains in addressing prevention: setting of targets for expansion of programs to prevent maternal-to-child transmission; new support for programs to prevent transmission among men who have sex with men; a call for a strategy to address the vulnerabilities of women and girls; a striking of the travel ban for HIV-positive individuals (further regulatory action is still required); and free drugs for opportunistic infections.
Yet several harmful provisions of the past were retained, and new problems were enacted.