After its first phase of implementation from 2003 to 2008, the U.S. Congress reauthorized the President's Emergency Plan for AIDS Relief (PEPFAR) for a second five years. The following analysis offers a critique of the policy environment and country Partnership Frameworks for youth in PEPFAR's second phase, which began in 2009. At a time when young people ages 15-24 account for four in ten new HIV infections among adults,1 this in-depth review finds that PEPFAR has made some important progress towards advancing young people's sexual and reproductive health, but its policy environment for youth is characterized by omissions and inadequacy. The report concludes with a set of recommendations for the policymakers governing PEPFAR (the U.S. Congress, the Office of the U.S. Global AIDS Coordinator (OGAC) and Partner Country governments) to design and implement the bold policy needed to support youth sexual and reproductive health and rights.