U.S. Funding for Global AIDS, Tuberculosis and Malaria PEPFAR and Beyond

The President's Emergency Plan for AIDS Relief (PEPFAR) was announced by President Bush in his 2003 State of the Union Address as a five-year, $15 billion initiative to combat global HIV/AIDS.  It was reauthorized in 2008 for up to $39 billion to fight HIV/AIDS.  PEPFAR is the largest international health initiative in history dedicated to fighting a single disease. 

Origins of PEPFAR

In 2002, President Bush announced a new $500 million International Mother and Child HIV Prevention Initiative - the first real scale-up in the fight against AIDS - which was later integrated into PEPFAR.  Additionally, for several years preceding President Bush's 2003 State of the Union Address, bipartisan leaders in Congress, including Senators Frist and Kerry and Representatives Leach and Lee, had also been considering legislation on global HIV/AIDS. After the President's announcement, Congress passed the "United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003" (PL108-25) in May 2003, which authorized the framework under which PEPFAR would operate.

2008 Reauthorization

In July 2008, President Bush signed into law H.R. 5501, the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act.  This legislation received strong bi-partisan support in the House and Senate, with 308 supporting votes in the House (230 Democrat, 78 Republican) and 80 (47 Democrat, 31 Republican) in the Senate.  This Act responded to President Bush's call in 2007 to expand and extend by another five years (to 2009-2013) the U.S. Government's commitment to PEPFAR.  It authorized $48 billion over five years to combat HIV/AIDS, tuberculosis, and malaria, and expanded health workforce development and capacity building of health systems. 

The law provided for expansion and better coordination of U.S. bilateral and multilateral efforts on AIDS, tuberculosis, malaria and AIDS-related research with a focus on 15 countries. The law authorized spending $15 billion over five years for HIV/AIDS, TB, malaria and research and created the Office of the Global AIDS Coordinator (OGAC) to manage and coordinate all HIV/AIDS programs in developing countries.  PEPFAR is centrally managed by the Department of State through OGAC.  In all countries, OGAC relies on U.S. Embassies and key implementing agencies including the U.S. Agency for International Development, the Centers for Disease Control and Prevention, the Departments of Defense and Labor, and the Peace Corps, to implement PEPFAR programs.  Dr. Eric Goosby is the current Global AIDS Coordinator, following Ambassador Mark Dybul's tenure.

The majority of PEPFAR financing is focused on 15 of the countries hardest-hit by HIV/AIDS in Africa, the Caribbean and Asia[1].  Though many believe PEPFAR refers only to the 15 focus countries, the US government is providing bilateral AIDS services, as well as TB services, in 33 countries.  U.S. bilateral funding for malaria is tracked separately, now that the President's Malaria Initiative has launched.

Program Goals

During its first phase, PEPFAR's goals were to reach 2 million people with life-saving antiretroviral drugs (ARVs), prevent 7 million new infections and provide care to 10 million people affected by the disease. With the successful reauthorization of PEPFAR, the initiative aimed to deliver increased results over the next five years, supporting ARV treatment for a total of 3 million people, preventing a total of 12 million new infections and providing care to more than 12 million people, including five million orphans and vulnerable children.  The launch of U.S. Global Health Initiative (GHI) in May of 2009 put PEPFAR at the center of its work on HIV/AIDS, increasing the target for ARV treatment from 3 million to 4 million, and sustaining the goals for prevention and care over the next five years (2009-2014).  In this next phase, PEPFAR will also more directly support and partner with countries in taking leadership of the responses to their epidemics. In addition, to support an expanded collective impact at the country level, PEPFAR is increasing collaboration with multilateral organizations including the Global Fund, UNAIDS, and the WHO.

[1] The 15 focus countries are Botswana, Cote d'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Vietnam and Zambia.