Edited sentence: After several years of America defending Big Pharma patents and refusing to distribute HIV medication in sub-Saharan Africa, PEPFAR is the policy pivot of the American government when the global health care community led by Cipla and Doctors Without Borders came to the consensus that they would break Big Pharma’s HIV patents and begin distributing HIV medication to sub-Saharan Africa.At the turn of the century the global health care community began pushing back on Western hegemony and took the initiative to break patents protected by America and the EU with the U.PEPFAR would be introduced exactly two years later at his 2003 State of the Union.The American government’s position was to defend the patents of Big Pharma and block distribution of HIV medication to sub-Saharan Africa.This was the situation when George W Bush was inaugurated in January 2001 and he continued the policy of his predecessor blocking HIV medication being distributed to sub-Saharan Africa even as the global health care community defied America and the EU and began distributing generic HIV medication to the region in the grips of a deadly public health crisis.Trade Representative’s Office providing Western leadership