religious or moral objection. The legislation states that “an organization that is otherwise eligible to receive assistance … to prevent, treat, or monitor HIV/AIDS shall not be required, as a condition of receiving the assistance, to endorse or utilize a multisectoral approach to combating HIV/AIDS, or to endorse, utilize, or participate in a prevention method or treatment program to which the organization has a religious or moral objection” (P.L. 108-25, p. 733). Further, the legislation states that “no funds made available to carry out this Act, or any amendment made by this Act, may be used to promote or advocate the legalization or practice of prostitution or sex trafficking. Nothing in the preceding sentence shall be construed to preclude the provision to individuals of palliative care, treatment, or postexposure pharmaceutical prophylaxis, and necessary pharmaceuticals and commodities, including test kits, condoms, and, when proven effective, microbicides. No funds made available to carry out this Act, or any amendment made by the Act, may be used to provide assistance to any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking” (P.L. 108-25, pp. 733–734). Finally, the legislation required that of the amounts appropriated, “an effective distribution of such amounts would be 20 percent of such amounts for HIV/AIDS prevention … of which such amount at least 33 percent should be expended for abstinence-until-marriage programs” (P.L. 108-25, p. 746).

Congress passed the Leadership Act, and on May 27, 2003, the President signed it to become P.L. 108-25, The United States Leadership against HIV/AIDS, Tuberculosis, and Malaria Act of 2003. The Leadership Act called for bold leadership by the United States in international HIV/AIDS programs; however, it stressed the overarching need to coordinate with local, national, and international partners. In particular, the act recognized that the new resources being provided could not meet all needs, and it sought to complement existing programs that might already be meeting some needs. The legislation stated that the Global AIDS Coordinator would collaborate and coordinate with civil sector organizations to plan, fund, implement, monitor, and evaluate all programs addressing HIV/AIDS.

The Leadership Act directed the President to submit a strategy meeting specified objectives (see Box 2-5) to the Committee on Foreign Relations of the Senate and the Committee on International Relations of the House of Representatives, the committees with jurisdiction over the legislation.

The PEPFAR legislation named 14 focus countries, which at the time accounted for more than half of the world’s HIV/AIDS cases. These 14