When President Bush announced the beginning of the President’s Emergency Plan for Aids Relief (PEPFAR) during his 2003 State of the Union speech, the five-year, $15 billion measure was announced as “the largest commitment ever by any nation for an international health initiative dedicated to a single disease.” Targeting 15 “focus countries,” most of which are in sub-Saharan Africa, the plan embraced a three-pronged strategy based around prevention, treatment and care.