Making a Mistake on Treatment – PEPFAR’s New Five-Year AIDS Strategy

Just when testing trends are so positive, just when the costs of medicines have plummeted to new lows, and just as scientific modeling and research shows that treatment reduces the risk of HIV transmission, funding – the lifeblood of AIDS programming – is being capped both by donor countries and their partners in the developing world that are suffering the worst of the global recession. As a result, people are beginning to stand in line and to die in that line while waiting for treatment. | More

85 Organizations call for IMF to support Financial Transaction Tax

85 organizations from around the world challenged the IMF to report the truth in a paper they are preparing for the G20 on how the banks should compensate for the massive government bailouts they received. The groups signed a letter calling for the creation of a new financial transactions tax (or FTT), which would assess a modest tax on trades of stock, currency, options, and other derivatives. | More

Obama’s FY2011 Global Health Budget: response to global AIDS flounders

On Monday, Feb. 1st, President Obama released his much-anticipated 2011 budget request. He and Congress had pledged to increase funding to ensure the US does its fair share toward getting everyone access to AIDS treatment. Instead his 2011 budget put a halt on this: it cut $50 million from the Global Fund to Fight AIDS, TB, and Malaria and gave less than a 2% increase (less than the cost of inflation) to global AIDS overall. | More

The AIDS crisis worldwide: There are 33 million people living with HIV worldwide. Each year, 2.1 million people die and 2.7 million more are infected. Two-thirds of HIV cases are found in sub-Saharan Africa. Half of new HIV cases are young people, and more than half are women. The epidemic continues to expand in the Caribbean and Latin American countries, Southeast Asia, and Eastern Europe. Four million people have access to lifesaving HIV treatment, but ten million need access immediately or they will die within three years. Only 45% of pregnant women in need of medicines to prevent mother-to-child HIV transmission have access.

 Background on PEPFAR: In 2003, after an activist campaign to win a multi-year commitment from the President of the US to fund global AIDS programs, President Bush announced the President’s Emergency Plan For AIDS Relief (PEPFAR). This was a $15 billion over five-year program to fight AIDS in fifteen focus countries. During the first five years of the program (2004-2008), the US contributed nearly $19 billion to fight AIDS ($6bn in Fiscal Year 2008 alone), and currently supports treatment for 2.4 million people worldwide. In 2008, PEPFAR was reauthorized for five more years.

From the beginning, PEPFAR was a massive expansion of US assistance to fight AIDS in the developing world. But it was not without problems. PEPFAR emphasized abstinence and fidelity programs over a comprehensive approach to fighting AIDS that includes condom distribution and comprehensive sex education. It did not fully address the epidemic in marginalized communities by requiring US-funded organizations to oppose prostitution (thus further stigmatizing sex workers), and would not fund syringe exchange programs, the single most effective public health measure to reduce HIV in injection drug using communities. It required generic drug manufacturers to receive time-consuming, costly and duplicitous approval by the US FDA in order for PEPFAR to purchase the pills. Oftentimes, these drugs had already received approval by the World Health Organization. Additionally, PEPFAR impacted already fragile local health systems by merely training existing health workers for HIV/AIDS care rather than helping to train, hire and retain new health workers. 

In March 2008, the House passed legislation that would continue PEPFAR for five years. Their plan, based initially on a campaign pledge of $50 billion over five years by then-Candidate Obama, included $48 billion over five years to fund AIDS, tuberculosis, malaria, microbicides development, health systems strengthening, training and retaining 140,000 new health workers and many other necessary programs. The new law repealed the earmark on funding for abstinence-only programs. For the first time, the bill also called for funding of inexpensive treatment for infections caused by AIDS (opportunistic infections), and nutrition programs. And the new law ended the legislative requirement that people with HIV who are not US citizens cannot travel to the US. In July 2008, after passing both the House and Senate, President Bush signed the US Global AIDS, TB and Malaria Reauthorization Act into law. 

Remaining needs: While many key problems with the first five years of the US global AIDS plan were addressed in the new law, it still falls far short of the need, especially for marginalized communities. Five major issues remain unsolved, and must be addressed by Congress and the next President in order for PEPFAR to effectively fight AIDS:

• Overall funding for global AIDS has remained stagnant in recent years. Congress and the President have used the financial crisis as an excuse to backtrack on the necessary commitment of $48 billion over five years for AIDS, TB and malaria. Flat-lined funding from the U.S. has signaled to other wealthy nations to cut or not increase funding. As a direct result of underfunding, people with AIDS who were promised treatment are being forced to wait in line for AIDS drugs. Too often, they will not make it to the front of the line. As of 2010, the year that wealthy nations committed to achieve universal access to AIDS treatment, 70% of people in need still lack access to life-saving medication.
• The new law does not include a bold target for the number of people who will receive treatment sponsored by the US government. Unfortunately, the Obama Administration has only called for treatment of four million people, which is only a slight increase from the number of people on treatment when President Obama took office. The US has a responsibility support treatment for six million people with HIV worldwide by 2013, and Congress should agree that this is the target number of people the US will provide treatment for.
• There should be no restrictions on prevention funding, including reporting requirements. The current bill requires that, if a country with a generalized epidemic spends less than 50% of its funding on behavior change programs (defined as abstinence and faithfulness programs), they are required to submit a report to Congress to explain why. Funding must also be directed towards syringe exchange programs, especially in countries like Vietnam and the Ukraine, to prevent HIV infection in injection drug users. To date, PEPFAR has drug its feet on allowing funding for syringe exchange, even though, in 2009, Congress repealed the federal ban on funding of syringe exchange.
• Organizations receiving US government funding should not be required to pledge to oppose prostitution, since this only further marginalizes sex workers.
• In many places in Africa, people receiving HIV treatment must take drugs that have harsh side effects, even though better versions are available. These higher-quality medications should be made available to people receiving treatment and treatment should start earlier at 350 CD4 cell counts. This will also have the necessary effect of reducing the cost of these better first-line treatments worldwide. Second- and third-line treatment remains out of reach for millions, as a result of a lack of generic competition.

• The US Treasury Department, which is very influential with the International Monetary Fund, must be instructed by Congress to end IMF restrictions on health and education spending by developing countries. The IMF currently imposes harmful macroeconomic targets on inflation, fiscal deficits, and currency reserves by poor countries. This has had disastrous effects, especially as it relates to scaling up health systems and increasing the supply of doctors and nurses.

Updated 2/8/10

WWW www.healthgap.org

Fact Sheet on Obama's 2011 Budget | Download

Health GAP Fact Sheet on PEPFAR 2 | Download

Press Release: Obama must fund syringe exchange worldwide, say activists | more

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Press Release: Lancet Editorial Misinterprets Key WHO Data about Global Health Initiatives | more

Press Release: Global AIDS Advocates shocked by drastic funding cuts in Obama's first budget | more

Board co-chair Brook Baker's discussion paper on international financing for health | more

91 organizations call for process to decide next Global AIDS Coordinator | Read Letter to Sec. Clinton

Take 2 minutes to comment on Transition Team website to call for swift action to implement Obama's bold plan to fight AIDS | more

Health GAP and allies submit recommendations for fighting global AIDS to the Obama transition team | Download the recommendations

1,000 AIDS activists rally and inaugurate Obama as the President who will change the way the US fights AIDS | more

Fact Sheet on the lack of treatment target in PEPFAR law | more

President signs landmark global health bill | more

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