Between 2004 and 2007, the US President's Emergency Plan for AIDS Relief (PEPFAR) cut deaths from AIDS by about 10% in 12 African countries, at a cost of $2,700 per life saved. So say researchers who published an independent analysis of the programme this week (E. Bendavid and J. Bhattacharya Ann. Int. Med. 150, 60520-117; 2009).

PEPFAR has pumped $15 billion into aid-recipient countries since 2004, and in 2008 was authorized to spend a further $48 billion over five more years (see Nature 457, 254–256; 2009). It did not reduce the number of people living with HIV, nor the proportion of the population with the disease, note Eran Bendavid and Jayanta Bhattacharya of Stanford University in California.

The researchers, who call the programme "essential and expensive", say they hope that their work will spur PEPFAR to evaluate the effectiveness of its spending.