The United States President's Emergency Plan For AIDS Relief (PEPFAR) is a United States governmental initiative to address the global HIV/AIDS epidemic and help save the lives of those suffering from the disease. Launched by U.S. President George W. Bush in 2003, as of May 2020, PEPFAR has provided about $90 billion in cumulative funding for HIV/AIDS treatment, prevention, and research since its inception, making it the largest global health program focused on a single disease in history until the COVID-19 pandemic. 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. As of 2021, PEPFAR has saved over 20 million lives, primarily in Sub-Saharan Africa. History PEPFAR began with President George W. Bush and his wife, Laura, and their interests in AIDS prevention, Africa, 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, and visiting The Gambia in 1990. In 1998, while pondering a run for the U.S. presidency, he discussed Africa with Condoleezza Rice, 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. She held the position until January 2021 when Angeli Achrekar filled the Acting role, from being Principal Deputy. In December 2014, PEPFAR announced a program PEPFAR 3.0