This paper examines how the GBV initiative is being introduced in Tanzania, one of the GBV focus countries, based on interviews in Tanzania in April 2012 with U.S. government officials, nongovernmental organizations, and implementing partners, as well as interviews in Washington, D.C. It describes the importance of this initiative for the work of PEPFAR and the Global Health Initiative (GHI), impediments to progress, why this program has the potential to provide valuable and timely lessons for achieving HIV-related goals and for improving health outcomes for women and girls, and priority steps for getting the best results in the future.