As we commemorate World AIDS Day Dec. 1, I am struck by how our outlook has changed over the years that we have spent fighting this pandemic.

I remember returning to Kenya in 1992 after a seven-year absence, and hearing that so many of the Kenyans I had known had died. When I asked why, I was told it was tuberculosis, or pneumonia. But when I probed a little deeper, I found they had died of AIDS. It was absolutely shocking. In those days, AIDS was a death sentence.

When Catholic Relief Services (CRS) started supporting its first HIV project 21 years ago in Bangkok, Thailand, the effort focused on community-based care. At that point, antiretroviral therapy was still a long way off. Even when it did become available in 1996, it was too expensive to be a viable option for resource-limited settings.

More than a decade later, I and other leaders at this agency began dialogues with influential people who made convincing arguments that we should get involved in antiretroviral therapy. All we needed was the right opportunity.

That opportunity arrived with the President's Emergency Plan for AIDS Relief (PEPFAR), historic legislation that pledged $15 billion over five years, partly to bring antiretroviral therapy to the poorest nations around the world. When a CRS-led consortium was awarded one of PEPFAR's largest grants in 2003, we were on the verge of implementing what has become one of the most complex initiatives in the agency's history --- and one of our most rewarding experiences to date.

The first time I saw our antiretroviral clinics in the field was during a visit to St. Mary's Hospital in Durban, South Africa. I met a woman who had come to the hospital to die. She had sold off everything she owned, said goodbye to her young children and come to St. Mary's, prepared to accept her fate.

But at the hospital, she was put on antiretroviral therapy, and when I met her, her fate had changed. She was about to be released from the hospital, and she had a set of issues she never thought she'd face: how to re-start her life; how to support her family. That she was alive and facing these issues was a miracle.

This miracle is being repeated thousand of times. Antiretroviral therapy is bringing hope to people where there was none. Families are being reunited. Fathers and mothers are able to resume working. Children are returning to school.

Next year, PEPFAR reaches the end of its initial five-year commitment. The program has already surpassed its original goals, responding to evident needs on the ground. In the next six months, Congress will be making decisions to reauthorize this successful initiative. By exceeding President Bush's commitment to double the program's value during reauthorization, we have the opportunity to continue and expand this historic outpouring of American compassion.

Through PEPFAR, CRS and its partners in the AIDSRelief consortium reach out in nine countries to provide antiretroviral therapy to 84,000 people, more than 6,200 of whom are children. With help, agencies like mine will do more. On World AIDS Day, I commend U.S. leadership on this critical humanitarian issue and recognize the incredible, hopeful efforts of people living with HIV around the world.

Ken Hackett is president of Catholic Relief Services, the international humanitarian agency of the Catholic community in the United States.