Behind the Breakthrough: How PIH Helped Build, Defend PEPFAR

The United States President’s Emergency Plan for AIDS Relief, or PEPFAR, was launched in 2003 by the Bush administration to support the global effort to reduce suffering from HIV/AIDS. Since then, the program has saved 26 million lives and prevented millions of HIV infections.

However, deeply intertwined in this lifesaving legacy is behind-the-scenes advocacy that has helped shape and sustain the program. For decades, leaders from Partners In Health (PIH) have been heavily involved in PEPFAR’s policy and programming. Unfortunately, PEPFAR is under threat from the current administration.

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Read on for a few key dates highlighting PIH’s history with PEPFAR and see how we’re uniquely positioned to protect its lifesaving legacy together.

1998 – The HIV Equity Initiative

PIH began the HIV Equity Initiative in 1998 in Cange, Haiti, when AIDS was the leading cause of death among young adults, and an estimated 6% of adults in the country were infected. The project provided lifesaving antiretroviral therapy to patients dying of AIDS at no cost to them—just two years after it was available to treat patients in the United States and Europe. 

At the time, this initiative was considered radical at best, and at worst, a waste of resources, impossible to sustain in impoverished communities. PIH set out to prove the opposite. As one of the first projects in the world to effectively deliver antiretroviral therapy in a poor, rural setting, the initiative—and its patients demanding and knowing that they needed more—would eventually provide the evidence for PEPFAR's massive scale-up of access to treatment for millions of HIV patients around the world.

2002 – Dr. Paul Farmer visits the White House to advocate for PEPFAR

In 2002, the late PIH Co-founder Dr. Paul Farmer was invited to the White House by Dr. Anthony Fauci to present his findings from the HIV Equity Initiative. The program’s success demonstrated the possibility of HIV care being delivered in resource-poor settings and was ultimately a key part of the evidence that convinced President George W. Bush to announce PEPFAR. His announcement began with a sentiment that remains true today: “Ladies and gentlemen, seldom has history offered a greater opportunity to do so much for so many….” Since its establishment in 2003, PEPFAR has uniquely had consistent bipartisan support.

2007 – Dr. Joia Mukherjee testifies before the Committee on Foreign Affairs

In 2007, PEPFAR was facing reauthorization, a process it goes through—like other legislation—every 5 years to allow lawmakers and advocates to set new priorities. This reauthorization was pivotal in moving away from addressing a crisis to expanding support for strengthening entire health systems, including training local health workers. On September 25, Dr. Joia Mukherjee, who was PIH’s medical director at the time, joined several global health advocates to provide testimony in front of the Committee on Foreign Affairs in favor of reauthorizing PEPFAR.

In addition to highlighting the work PIH was doing with PEPFAR’s support, in her statement, Mukherjee said, “I urge you to build on the successes of PEPFAR, and to use the AIDS crisis to examine and address the illness and suffering throughout the world; not to preserve the first five years of PEPFAR in the museum of unrealized possibilities, but rather as the beginning of a movement to strengthen health systems as a response to combat the worst epidemic in the history of mankind.”

2018 – PIH Engage begins annual advocacy to sustain PEPFAR's funding levels  

PIH Engage is a grassroots network of volunteer community organizers mobilizing local communities to build a global movement for the right to health. The Engage network spans the U.S. and utilizes advocacy to target political action towards congressional offices.

Public funding wouldn’t be able to survive without pressure from advocates. Since 2018, Engagers have been advocating annually for sustained funding for PEPFAR and its overwhelmingly positive track record, ensuring that voices from both patients and clinicians who rely on PEPFAR were represented in the decision-making processes. In all the years that they’ve been advocating, funding levels have either increased or remained steady—until the Trump administration took office in 2025.

2025 – PIH participates in a congressional briefing on PEPFAR

Over 20 years after PEPFAR was announced, Dr. Mukherjee and colleagues were back in front of Congress, defending PEPFAR. In January of 2025, funding for the program was frozen, and in February and March, 65 percent of USAID PEPFAR programs were terminated. In June, the Trump administration tried to cut significant funding to PEPFAR as part of a larger rescissions package that gutted foreign aid. In October, CDC PEPFAR programs were cut down 35 percent globally. In response, PIH used both constituent and expert power to inform Congress and help protect PEPFAR’s lifesaving legacy.  

Zanmi Lasante (ZL), PIH’s sister organization in Haiti, is one of the main implementers of PEPFAR funding in the country. In collaboration with congressional champions for PEPFAR, ZL leaders—including Executive Director Dr. Wesler Lambert, Director of Development Coralie Noisette, and Director of Infectious Diseases Dr. Alain Casseus—provided firsthand accounts of how U.S. government funding cuts were harming their patients in Haiti.  

“Every line item in the budget, there is a person, a patient, a nurse, a family,” Dr. Casseus said during the briefing, “I’m asking you to remember the people behind these numbers.”

2026 – PIH provides transparency and forces accountability

After a year of funding cuts in 2025, PIH continued to monitor the State Department’s spending in 2026 and discussed concerns with policymakers. During this analysis, it was discovered that CDC funding was cut significantly for programs happening this year, which would impact 12 million people living with HIV across 51 countries and regions who receive support from PEPFAR. For PIH patients in Haiti, without PEPFAR funding, 18,000 people risk losing access to lifesaving treatment. 

After discovering this, PIH began sounding the alarms with local and national media, hoping to build constituent pressure against these cuts. PIH’s spending dashboard and analysis led to several news outlets—including the New York Times, Washington Post, NPR, Science, and Devex—covering the emerging impacts of these cuts on programs and patients. Since then, promising discussions have occurred behind the scenes to avoid such a dramatic cut in funding, allowing services to continue.

It would be reassuring to report that media pressure and congressional oversight have secured PEPFAR’s future, and that’s where the story ends. However, our fight to protect PEPFAR is far from over. The advocacy started in Cange by Zanmi Lasante and Dr. Farmer in 1998 must continue.

As the U.S. State Department looks to sunset PEPFAR funding over the next five years through its "America First Global Health Strategy,” PIH will keep advocating against an estimated $1 billion in cuts and the tying of aid to the extraction of minerals—an approach that is already leading to humanitarian funding shortfalls in Malawi, amid a severe food insecurity crisis.

If we’ve learned anything from PIH’s history with PEPFAR, it’s how important our voices, our experiences, and our expertise are in protecting its lifesaving programming. This is your chance to be a part of that legacy alongside us.