Since the creation of the PEPFAR in 2003, the coordinated global effort to combat the HIV/AIDS pandemic has continued to expand on its successes in diagnosing and treating people living with HIV (PLHIV). UNAIDS estimates that by the end of 2020, 27.5 million PLHIV were receiving antiretroviral therapy (ART). This represents a greater than three-fold increase since 2010, and a more than 20-fold increase since 2003. It also represents an increase of 2.1 million people (or 8.3%) during 2020, despite the many challenges presented by the COVID-19 pandemic. These gains have been largely driven by PEPFAR, especially in countries with the highest burden of disease. The massive, rapid expansion in access to treatment stands as one of PEPFAR’s greatest achievements for many reasons: not only has ART saved the lives of millions of PLHIV and increased their life expectancy to near-normal levels, but it yields a reduction in the levels of HIV virus that causes it to act as the strongest available intervention in preventing HIV transmission.