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Pepfar, the largest international health initiative in history, was launched by President Bush in 2003 with the goal of providing two million individuals infected with HIV with antiretroviral drugs, funding care for ten million people affected by the illness and preventing seven million new infections. The scheme, which was just re-approved by Congress for the next five years, cost about $18 billion - the cost of about two weeks of the Iraq war - between 2003 and 2008.

Pepfar focused on the fifteen countries that account for 50% of all HIV infections in the world - all of them are in sub-Saharan Africa with the exception of Vietnam, Haiti and Guyana. Prior to Pepfar, the number of sub-Saharan Africans receiving antiretrovirals was about 50,000 - now it is two million. Pepfar has also funded the training of millions of medical personnel, the distribution of some 2.2 billion U.S. government issue condoms, and supported the prevention of mother-to-child transmission during some sixteen million pregnancies.

Pepfar has been criticized because by law, a third of the funds earmarked for prevention - which are 20% of the total - have to be spent on abstinence programmes, which are sometimes run by faith groups. The general American aversion to large foreign aid projects has also meant the Bush administration kept largely quiet about the initiative, which was of questionable political value despite being an issue that was by all accounts of great personal importance to the president. The tens of millions of lives it has transformed is one of the most positive aspects of Bush's legacy, as well as having sizable diplomatic and security benefits for the U.S. by helping to prevent the collapse of third world governments under the pressure of HIV/AIDS.


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