The creation of the President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003 marked a historic moment in the U.S. and global response to the HIV epidemic. PEPFAR, announced by the president and authorized by Congress in the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003, P.L. 08-25 (The Leadership Act),2 was critical to driving forward an emerging global consensus on the ethical imperative to scale up antiretroviral treatment (ART) and to bolstering confidence that mass treatment could be achieved in even the most resource-poor settings. By most accounts, treatment scale-up is seen as one of U.S. global HIV/AIDS efforts’ signature achievements.
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