In 2004, President George W. Bush announced his Five-Year Global HIV/AIDS Strategy. Also known as the President's Emergency Plan for AIDS Relief (PEPFAR), the plan committed the U.S. to provide $15 billion over five years toward AIDS relief in 15 countries in Africa and the Caribbean, and in Vietnam. About 20% of the funding, or $3 billion over five years, was allocated for prevention. The program required that, starting in fiscal year 2006, one-third of prevention funding be earmarked specifically for abstinence-only-until-marriage programs. The earmark had numerous critics, including global AIDS prevention advocates, the U.S. Government Accountability Office, and a Congressionally authorized three-year evaluation of PEPFAR by the non-partisan Institute of Medicine.
During its 2008 reauthorization of PEPFAR, Congress dropped the earmark, resorting instead to more flexible spending directives encouraging countries to spend at least 50% of prevention funds on abstinence and fidelity programs.