Since the advent of effective HIV treatments in the 1990s, the management of HIV/AIDS has undergone several revolutions. Most recently, in the 2010s, knowledge that antiretroviral therapy for HIV is also effective at preventing transmission has led to a paradigm called “treatment as prevention.” Treatment as prevention programs focus on integrating clinical, epidemiological, and public health prevention infrastructures to keep people living with HIV engaged in medical care. Since 2003, the U.S. has driven the response to HIV/AIDS in the Global South through a program called the President’s Emergency Plan for AIDS Relief (PEPFAR). PEPFAR has always required grantee nations to create national strategies and HIV integrated plans. However, the U.S. only released its own national HIV/AIDS strategy in 2010, and domestic integrated planning requirements in 2015. Drawing on an analysis of U.S. HIV/AIDS policy documents and multi-sited ethnography with U.S. HIV/AIDS professionals, this talk shows how the U.S. leveraged PEPFAR to implement HIV integrated planning in the Global South, and then brought this knowledge back to inform domestic HIV integrated planning in the era of treatment as prevention. What emerges is a curious story of American exceptionalism in health governance, wherein the U.S. employs knowledge from a tool of neo-colonial health diplomacy to re-shape the management of its own domestic HIV/AIDS crisis.