In this viewpoint article in the Journal of the International AIDS Society written ahead of World AIDS Day (December 1), KFF’s Jennifer Kates and co-authors Brian Honermann and Gregorio Millett of amfAR explore the implications of shifts in the global economic and political environment for the future of PEPFAR, the U.S government’s global HIV program created under President George W. Bush and credited with changing the trajectory of the global HIV/AIDS pandemic.