A Forgotten Anniversary: PEPFAR's real birthday


A woman walks with her son near the Ethiopia-Somalia border.


Roberto Schmidt

For anyone who cares about the global AIDS fight, today should be a day to celebrate the saving of millions of lives in the developing world.

Ten years ago today – June 19, 2002 – President Bush stepped into the Rose Garden to announce what at the time was an unusual new initiative: a $500 million program to stop the transmission of HIV passed from mothers to children during birth.

At the time, it was a ground-breaking idea, especially from a conservative Republican president who earlier had cast doubt on the effectiveness of foreign aid. His plan doubled what the Clinton administration was spending on global AIDS.

In announcing his initiative, Bush said, “the global devastation of HIV/AIDS staggers the imagination and shocks the conscience. The disease has already killed over 20 million people and it's poised to kill at least 40 million more.”

Not everyone was applauding.

ACTUP – the well-known AIDS activist group – sent out a press release later on June 19, belittling Bush’s announcement. Its press release called it the “Bush global AIDS sham announcement” and demanded $2.5 billion for global AIDS.

But what ACTUP and virtually no one else knew at the time – with the exception of a small circle of White House advisors – was that Bush already was thinking of doing something larger than even the activists’ dreams.

In his speech, Bush foreshadowed this: “As we see what works, we will make more funding available.”



Soon after the speech, Bush pulled aside his deputy chief of staff, Joshua Bolten, and told Bolten to lead an effort to devise an AIDS plan for Africa and elsewhere that was much larger. That kicked off more than seven months of secretive deliberations, culminating in an announcement on Jan. 28, 2003, in Bush’s State of the Union address, proposing a $15 billion global AIDS program for the next five years.

That State of the Union address will likely go down as Bush’s most important – and controversial. In it, he prepares the United States for a coming war with Iraq before announcing arguably the most sweeping US global humanitarian effort since the Marshall Plan after World War II. The United States, to date, has earmarked more than $38 billion for global AIDS since the beginning of Bush’s initiative, called PEPFAR, for President’s Emergency Plan for AIDS Relief. (The Marshall Plan cost roughly $13 billion to rebuild large parts of Europe.)

More from GlobalPost: AIDS: A Turning Point

In the years since, PEPFAR has been credited for saving millions of lives, most of them in Africa.

Many people will look at the State of the Union address as the beginning of PEPFAR. But it really began with an under-the-radar announcement of a program to save the lives of babies, and the whispered words of a president to a key aide in the quiet moments after.

Checking in on PEPFAR's Progress 

While many factors have affected HIV/AIDS rates in PEPFAR's 15 focus countries, the change in prevalence rates from 2003 to 2008 is one indicator that might show us if the program is moving toward its goals.

Graphic by Emily Judem/GlobalPost. Data source: PEPFAR Archive and Joint United Nations Programme on HIV-AIDS.