U.S. Government interests have shifted significantly since the 1994 genocide from a strictly humanitarian concern focusing on stability and security to a strong partnership with the Government of Rwanda focusing on sustainable development. The largest U.S. Government programs are the President's Emergency Plan for AIDS Relief (PEPFAR) and the President's Malaria Initiative, which aim to reduce the impact of these debilitating diseases in Rwanda. Other activities promote rural economic growth and support good governance and decentralization. Overall U.S. foreign assistance to Rwanda has increased fourfold over the past four years.