An Oral History of PEPFAR: How a "Dream Big" Partnership is Saving the Lives of Millions

December 1, 2018 / Updated: December 14, 2018

PEPFAR: An Oral History

How a “Dream Big” Global Health Partnership is Saving the Lives of Millions

View Part I: 2000-2007

Part II: 2007-2018


Remarkable Progress Leading to Continued Support

PEPFAR has been reauthorized three times since its initial passage, and has found consistent support in the halls of Congress. PEPFAR has represented a place where Americans from both sides of the aisle can come together and feel good about the work they are doing.

In 2007, with PEPFAR coming up for reauthorization, President Bush was again thinking big.

Bicycles loaded with supplies line the background as Mrs. Laura Bush delivers remarks during her visit to the Mututa Memorial Center Thursday, June 28, 2007, in Lusaka, Zambia (Lynden Steele / White House)

President Bush holds Baron, the son of South African Kunene Tantoh, in the Rose Garden of the White House on May 30, 2007. While his mother is HIV positive, Baron was born without HIV. (Krisanne Johnson / White House)

Mark Dybul and lawmakers look on as President Bush gives remarks before signing H.R. 5501, the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008, on July 30, 2008.

“Some people call this success. I call it a good start.”
(Photo by Joyce N. Boghosian / White House)

As the Bush Administration came to a close in 2009, PEPFAR had supported life-saving treatment for more than 2.1 million people and care for more than 10.1 million people worldwide. While U.S. taxpayers funded the aid, in 2007 alone, more than 2,200, or 87 percent, of the partners were indigenous groups – and one-quarter were faith-based.

Upon reauthorization in 2008, PEPFAR was expanded to support treatment for an additional three million people, the prevention of 12 million new infections, and care for 12 million people, including five million orphans and vulnerable children.

Numbers don’t tell the story, however. The results were visible in the people.

Secretary of State Condoleezza Rice at the State House in Dar se Salaam, Tanzania on February 17, 2008. (Jim Watson/AFP/Getty Images)

Tatu Msangi holds her daughter Faith on February 17, 2008, in Tanzania. Msangi discovered that she was HIV positive after she became pregnant — but Faith is HIV-free. (Mandel Ngan/AFP/Getty Images)

Mohamed Kalyesubula of Uganda waves to acknowledge the applause of guests on July 30, 2008 at the White House signing ceremony of H.R. 5501 reauthorizing PEPFAR. (Joyce N. Boghosian / White House)

Under President Barack Obama, PEPFAR expanded and continued to express American compassion for those affected by HIV/AIDS around the world. Between 2009 and 2011, the number of partner countries expanded from the original 15 focus countries to 33 countries. Today, PEPFAR partners with over 60 countries around the world.

On World AIDS Day 2011, President Obama announced ambitious new goals for the program. Among these was a 50 percent increase in PEPFAR’s treatment target, to six million people supported by the end of 2013.

In 2018, because of PEPFAR, more than 14.6 million people received lifesaving antiretroviral treatment, 95 million people had been tested for HIV, 2.4 million babies had been born HIV-free to infected mothers, and 6.8 million orphans, vulnerable children, and their caregivers had received support. The $80 billion investment has saved an estimated 17 million lives between 2003 to 2018.

On December 12, President Donald Trump signed the latest re-authorization of PEPFAR, ensuring that the United States will continue its leadership in the fight against HIV/AIDS for five more years.

President Barack Obama delivers the 2016 State of the Union Address. (White House)

Vice President Mike Pence commemorates the 30th annual World AIDS Day and announces the Trump Administration’s intent to sign the PEPFAR reauthorization. (via Twitter @VP)

As much progress had been made in the battle with HIV/AIDS, other health issues remain a concern. Some, like cervical cancer, are becoming more prevalent as women living with HIV are more susceptible to the disease. The Bush Institute’s Pink Ribbon Red Ribbon partnership, followed by Go Further, extended the work of PEPFAR to address women’s cancers.

President Bush attends the re-opening of the Mosi Oa Tunya Clinic in Livingston, Zambia July 1, 2013, after being renovated as part of Pink Ribbon Red Ribbon. (Paul Morse / George W. Bush Presidential Center)

A clinic worker helps a patient with forms at the Mosi Oa Tunya Clinic in Livingston, Zambia July 1, 2013, after being renovated as part of Pink Ribbon Red Ribbon. (Paul Morse / George W. Bush Presidential Center)

Moving Forward

A Legacy of Saved Lives and Beyond

To date, PEPFAR has saved millions of lives. It has brought hope where there was despair. And its benefits go beyond saving lives. PEPFAR is a smart investment that is also good for Americans. PEPFAR has facilitated better governance and accountability, more responsive healthcare systems, and stimulated economies. PEPFAR has also built a platform into which other healthcare services can be integrated.

Video: “Auntie” Bridget Chisenga sends a video message to the audience at Engage at the Bush Center, presented by Highland Capital Management, to open The Lazarus Effect, 15 Years Later. (George W. Bush Presidential Center)

Gary Edson plays soccer with locals during the renovation of the Mosi Oa Tunya Clinic in Livingstone, Zambia, on June 29, 2013. (Paul Morse / George W. Bush Presidential Center)

Children celebrate at the Therisanyo Primary School in Gaborone, Botswana, April 4, 2017. (Paul Morse / George W. Bush Presidential Center)

Video: This clip from the Have it All documentary highlights PEPFAR’s impact on Botswana.

In 15 years since the creation of PEPFAR, the program had achieved remarkable results in the fight against disease. Today, because of the commitment of foreign governments, investments by partners, the resilience of the African people, and the generosity of the American people, millions of lives have been saved. Millions more babies have been more HIV-free to infected mothers.

In 2017, President and Mrs. Bush traveled to Windhoek, Namibia and met with newborns and their moms. Almost all of the mothers were living with HIV, but their babies were disease free.