$50B FOR THE US GLOBAL AIDS EFFORT: DETAILS AND RECOMMENDATIONS
The global AIDS crisis is a massive challenge. Forty million people are living with AIDS. There will be 20 million AIDS orphans by 2010. Seven million people need treatment right now, and only two million have access to it.
Due in part to President Bush's dramatic increase in funding for global AIDS, we've come a long way from the late Nineties, when less than one percent of people who needed treatment worldwide could get it.
But it's a historic tragedy that only 28% of people now in clinical need have access to lifesaving HIV treatment.
The US must keep our promises to people in the developing world: of getting two million people on treatment that's supported by the US government by 2008 and coming as close as possible to universal access to treatment by 2010.
In order to keep our promise to the world and move towards ending AIDS, our next President must fight for $50 billion for the next five years of the US Global AIDS Initiative (2009-2013) and ensure treatment for our fair share of the people in impoverished countries in need of HIV medicine.
Background
In 2003, after an activist pressure campaign, President Bush and Congress launched a five-year, $15 billion program to fight AIDS, including $10 billion in new money, called the President's Emergency Plan for AIDS Relief (PEPFAR).
PEPFAR funds treatment, prevention, and care for people living with and at risk for HIV in fifteen focus countries. The initiative promised to prevent seven million new infections, and to treat two million people — about one-third of those in clinical need of treatment.
Because of ongoing advocacy by people living with HIV/AIDS and allies for needed additional funding for PEPFAR and the Global Fund to fight AIDS, Tuberculosis and Malaria and other parts of the program, the US is likely to have spent about $19 billion by the time PEPFAR expires at the end of 2008. In fact, this year President Bush requested $5.8 billion for global AIDS, TB and malaria funding, and Congress is on track to appropriate more than $6B for AIDS alone.
On May 30, 2007, in a high-profile speech in the Rose Garden, President Bush sadly undercut his own program by proposing to "double" PEPFAR to $30B over the next five years. But since the US is already on track to spend $6B in 2008 alone, President Bush's plan won't actually double funding but instead marks a rapid slow-down in a program that should be accelerating dramatically.
Thousands of AIDS activists in the US and around the world criticized Bush for his inadequate funding proposals, but this criticism was often lost in shallow media coverage of the event.
Digging deeper, the deceleration of PEPFAR under Bush's new plan was most apparent in newly-reduced treatment targets. By the end of the first five years of the 2003 PEPFAR plan, the U.S. committed to treat two million people. Outgoing President George W. Bush now proposes in 2007 to convert a five-year program to support treatment for 2 million people to a TEN year program to treat just 2.5 million people by 2013 — just half-a-million more people over five years.
This slow down is immoral and unacceptable, and represents resignation to an accelerating epidemic just as we are poised to turn a corner towards historic progress.
Because the US controls one-third of the world's economy, our government should fund one-third of the response to the global AIDS crisis, which is estimated to be $50 billion during the next five years of the US Global AIDS Initiative — and we should provide treatment for one-third of those in clinical need globally.
Do What Needs to Be Done to Keep The Promise:
The next 5 years of PEPFAR will cost $50 billion. This breaks down to:
When PEPFAR was announced, the US agreed to pay for the treatment of two million people, or about one-third of those in clinical need, over five years. In the next five years, we'll need to continue treatment for these two million people — and we'll need to add at least another two million people to the program to keep our one-third share going as the need increases worldwide.
The program will also need to cover newer first and second-line therapies for those who become resistant to first-line HIV treatments. While the price of second-line treatments are falling, there are fewer generic equivalents for the new drugs so far, and therefore they're still more expensive that first-line therapy.
To keep the promise of universal access, PEPFAR should grow beyond the 15 initial focus countries to add other nations rapidly accelerating or high-prevalence countries like Malawi, where many lives can be saved and many HIV infections can be prevented with a focused, intensive effort.
The Global Fund was created in 2001 as a multilateral, country-driven funding mechanism to fight AIDS in developing nations. Donor countries like the US contribute to the Global Fund, while recipient countries and organizations that work in poor countries write proposals for funding.
Unlike US bilateral aid, which works only in 15 countries and has restrictions on how prevention funding can be spent, the Global Fund works in over 140 countries around the world, and its prevention funding does not have strings attached. This means the money can be used for proven effective programs like comprehensive sex education and needle exchange. In April 2007, the Global Fund Board of Directors agreed to a new target funding size of $8 billion. The US must dramatically increase our support for the Global Fund by increasing our yearly contribution to $2.7B by 2013.
Before PEPFAR, the US was slated to spend approximately $5 billion on global AIDS programs between 2004 and 2008. These programs have seen only marginal increases in funding since PEPFAR began, and many development groups are seeking modest increases to funding levels.
To meet our stated goals of treating two million people by 2008 and aiming for universal access to HIV treatment by 2010, we must invest significant new resources in the training and retention of health workers in Africa.
Right now, there's a shortage of health workers in sub-Saharan Africa, where at least 1.5 million additional health care workers are needed to treat people who need access to lifesaving HIV medications.
This shortage is the result of lack of training opportunities, poor pay and working conditions and of immigration policies in the US and other western countries that lure trained doctors and nurses away from Africa to the West. International Monetary Fund policies also play a role by imposing funding conditions that limit the amount poor countries can spend on health and education.
These factors must be addressed as part a new initiative to fund healthcare workers in Africa. And any initiative should be seen as a powerful opportunity to employ and provide economic empowerment for hundreds of thousands of people living with HIV/AIDS to direct and provide care to our brothers and sisters in need as community health workers.
LINKS TO MORE INFORMATION
08 STOP AIDS platform and related activism
Universal Access to HIV Prevention, Treatment, Care & Support by 2010
2001 United Nations declaration: http://data.unaids.org/publications/irc-pub03/aidsdeclaration_en.pdf
2006 United Nations declaration: http://data.unaids.org/pub/Report/2006/20060615_HLM_PoliticalDeclaration_ARES60262_en.pdf
World Health Organization report on universal access:
www.who.int/hiv/toronto2006/towards universal access.pdf
PEPFAR links
Presdent's Emergency Program for AIDS Relief
White House PEPFAR Fact Sheet:
http://www.whitehouse.gov/news/releases/2003/01/20030129-1.html
PEPFAR's annual meeting in South Africa 2006
http://www.blsmeetings.net/implementhiv2006/index.cfm -
USAID's PEPFAR fact sheets
http://www.usaid.gov/our_work/global_health/aids/pepfarfact.html
Discussion of PEPFAR at AVERT.org: http://www.avert.org/pepfar.htm
PEPFAR Partners:
http://www.avert.org/pepfar-partners.htm
The Global Fund
The Global Fund to Fight AIDS, Tuberculois & Malaria:
