Last year Congress asked the Institute of Medicine to review the performance of the President’s Emergency Plan for AIDS Relief (PEPFAR) over its first three years. After visiting 13 of PEPFAR’s 15 operating countries, the panel praised it for delivering lifesaving ARVs to more than a million positive people worldwide. But the institute also issued stern pointers. First: Stop requiring that a third of the $300 million annual prevention budget go to abstinence-based education. Second: Stop making the Food and Drug Administration reapprove drugs that the World Health Organization has already endorsed. Third: Stop barring taxpayer money from funding IV-drug-needle exchanges. “The [PEPFAR] leadership seem to be moving toward these things,” says the institute’s Charles Carpenter, MD. “But they have political realities to deal with.” Now it’s up to Congress to upgrade those pointers— into law.