This paper deals with the question: "Why does the U.S. aid project to cambat HIV/AIDS in Africa, called PEPFAR, use a strategy that has been shown to be couterproductive?" The author uses an anthropological approach, based on theory of "aid as a gift" inspired by work of Mauss and Stirrat& Henkel. The study demonstrates that the interests that lie behind PEPFAR have had a greater influence on the choice of strategy than the declared goals. It is concluded that evaluations of development assistance should focus as much on the background interests of the givers as the declared objectives..