When the U.S. President’s Emergency Plan for AIDS Relief initially began its operations in sub-Saharan Africa in 2003, only half a million people in the region were receiving lifesaving antiretroviral treatment. Today, PEPFAR is working in more than 50 countries and supporting more than 14 million people with treatment, making it the biggest player in the HIV/AIDS funding landscape.
In the past 16 years, PEPFAR has changed and evolved as both politics and the HIV epidemic have shifted. In recent months, as the Trump administration has sought to exert greater influence over U.S. global health policy, the initiative has faced new demands and challenges.
PEPFAR released a new strategy focusing resources on 13 high-priority countries, an expansion of the "global gag rule" created new oversight and ethical dilemmas for PEPFAR's implementing partners, and U.S. Global AIDS Coordinator Deborah Birx has driven a push to direct 70% of PEPFAR's funding to "indigenous organizations.”