Bush AIDS Proposal an Important Step, but not a Doubling of Current Funding

As the President prepares to attend the G8 Summit June 6-8 in Germany, he is announcing new proposals on global development to showcase US leadership. Today he proposed that the next five-year phase of the US global AIDS plan provide $30 billion in US assistance to impoverished countries, mainly in Africa.

"Of course, we welcome the President's support for action to address HIV/AIDS," said Dr. Paul Zeitz, Executive Director of the Global AIDS Alliance. "The US program has done a lot of good, primarily in care for orphans and AIDS treatment, and today the President reaffirmed its continuation."

"But, the reality is that as the tide of HIV/AIDS rapidly rises we are not even treading water," said Zeitz. "This is not a plan for victory in the fight against AIDS. Looking at the details, it's clear that this plan is for a modest funding increase. It is far below what is needed to get ahead of the AIDS virus and meet new international commitments, including to provide services for children."

The President provided no details on what he would ask Congress to provide for the plan for fiscal year 2009. But, it is clear that the plan would not be a doubling of existing spending levels over a five year period. In fact, $30 billion is about what the US is already on track to spend over the next five years even without the President's announcement.

"This proposal is being described by some as a doubling of the US response to global AIDS," said Zeitz. "That is a misconception."

For fiscal year 2007 Congress approved $4.5 billion for AIDS, TB and malaria programs (excepting the new bilateral malaria initiative). For fiscal year 2008 the President requested $5.4 billion, which Congress seems likely to approve. If the next phase of the US global AIDS response simply held to this 2008 level over a five year period it would cost $27 billion, or nearly what the President proposed today.

In 2003, President Bush proposed a commitment of $15 billion, and a doubling of that would, indeed, be $30 billion. However, much has changed in the last four years. Since 2003, Congress has significantly raised the level of spending on the initiative. Then, last year, at a major UN meeting on AIDS, the US agreed to back universal access by 2010 to HIV/AIDS prevention, treatment, and care, including services for orphaned children, and reaching this goal requires a much higher level funding. And, since 2003, it has become obvious that unless the US provides a much greater investment in health care systems programs receiving US dollars will not be able to make efficient use of these resources.

"Congress should not reauthorize the global AIDS program at the level the President proposes, but rather at a level that reflects these new conditions," said Dr. Zeitz. "Candidates for US President should also not accept the Bush plan, but rather base their own proposals on what is really needed. They should do what the President seemed to do but did not, that is, propose a doubling of US spending to reach about $50 billion, galvanizing an even greater global response."

The fine print of today's proposal also shows a radical reduction in US support for HIV/AIDS treatment, even as the world is racing to meet the 2010 deadline of universal access. Treatment has been one of the most successful aspects of the US AIDS program, and now the US is providing treatment to about 33% of those people who need it. This is appropriate because the US represents about a third of global wealth. Yet, today the President proposed that the next five-year phase of the US AIDS program provide treatment to only 2.5 million people, or about 20% of the 12 million people expected to need treatment in 2013.

"Treatment and prevention work together, and we need full funding for both to succeed in stopping HIV/AIDS," said Dr. Zeitz. "This proposal to radically reduce US support for treatment is both alarming and unwarranted. Our country made a commitment to using its leadership to help the world reach universal access to treatment. That is a solemn promise and it must be kept by the Congress and the next President."

Leadership in Congress should authorize -- and fully finance -- a much bolder US response than what the President proposed, in part because it would also serve the interests of the United States. Global health threats must be effectively confronted, since many can affect the US directly. For instance, extremely drug resistant tuberculosis (XDR-TB) is now spreading, exacerbated by the prevalence of HIV, and cases have already been found in the US. A bold US plan would strengthen health systems in order to make the AIDS and TB response more effective, helping countries contain not only XDR-TB but other threats to the US, such as a possible human influenza epidemic.