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In 2003, President Bush proposed PEPFAR, the President's Emergency Plan for AIDS Relief. Launched in 2004, the program was to be a five-year, $15 billion effort for education and treatment for regions in Africa, Asia and Latin America with high rates of HIV infection.

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As of December, the United States had dedicated about $12.9 billion to PEPFAR, which was scheduled to expire in September 2008. The program has been praised for staying on track with the monetary commitment; for emphasis on prevention and prophylaxis; for empowering countries to assess their own needs and design local strategies; and for increasing the number of people receiving treatment for HIV infection. Criticisms focus on ideology, specifically restrictions on sexual and reproductive counseling, and encouragement of abstinence programs, especially when siphoning money or person-power away from other efforts. (By law, one-third of funds to focus countries must go to abstinence-until-marriage programs.) Bush has proposed extension of PEPFAR for another five years, with an additional $30 billion of funding. In a Dec. 13 hearing of the Senate Foreign Relations Committee, members called for reauthorization of PEPFAR. In February 2007, the president asked for $5.4 billion in fiscal year 2008 for it, and on Dec. 26, he signed a spending bill that included about $5 billion for the program, bringing the five-year total almost $3 billion past the promised $15 billion amount.