Between 1995 and 2008, worldwide global investment in improving health in developing countries increased from $8 billion to nearly $25 billion.1 A main reason for this substantial increase was the creation of new institutions including the Gates Foundation; the Global Fund to Fight AIDS, Tuberculosis and Malaria; the GAVI Alliance; and, most importantly, the President's Emergency Plan for AIDS Relief (PEPFAR) program.
Created by President George W. Bush in 2003, PEPFAR was, as its website says, “launched to combat HIV/AIDS.”2 The program targeted 15 “focus” countries, mostly chosen for their high rates of human immunodeficiency virus (HIV) and AIDS but also for their government's willingness to address the problems of HIV/AIDS as well as larger US geopolitical strategic reasons. PEPFAR has been the largest financial commitment of any country to global health and to treatment of any specific disease worldwide.
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