Four principles for expanding PEPFAR's role as a vital force in US health diplomacy abroad.

The President's Emergency Plan for AIDS Relief (PEPFAR) is the leading platform for US health diplomacy and a symbol of American capacity to achieve constructive and beneficial change. The program now faces an evolving context for its work that includes, on the one hand, domestic fiscal pressures in the United States, but on the other, the potential for substantial gains against the AIDS epidemic around the world. Continued success in advancing America's humanitarian and diplomatic interests through global health requires the United States to maintain robust investments in PEPFAR; implement a strategic plan to achieve an AIDS-free generation; use the program as a foundation to strengthen health systems generally and enable them to address broader health issues, such as chronic and noncommunicable diseases; carefully manage the transition to country "ownership" of the fight against HIV; and achieve greater coherence in US government health-related policy.