[HEALTHGAP] Science Soars - PEPFAR Budget Plummets

Baker, Brook b.baker at neu.edu
Tue Feb 14 11:53:28 EST 2012

The science of HIV prevention, treatment, and care has soared as there are
promising advances on treatment as prevention, pre-exposure prophylaxis,
prevention of vertical transmission through full HAART to pregnant women,
new devices for safer and cheaper circumcision, new point of care
diagnostic tests for HIV and TB, etc.

And funding was set to soar as well - starting at a high of $50 billion
for global HIV/AIDS alone (Obama's 2008 campaign promise FY2009-13) and
then at $39 billion for global HIV/AIDS (PEPFAR reauthorization).  Instead
of soaring budgets, we got stalled budgets FY2009-2012 (Kaiser figures:
$6.7 billion FY 2009; $6.9 billion FY 2010; $6.8 billion FY 2011; and $6.7
billion FY 2012).  This year's FY 2013 budget proposal contains a whopping
$546 million dollar cut to PEPFAR (partially offset by a $350 million
increase to the Global Fund) resulting in an overall decrease in global
AIDS funding down to $6.5 billion.

If we do the math based on these rough estimates, total US global AIDS
funding commitments (not disbursements, which are substantially less) are
only $33.6 billion - a whopping $5.4 billion less than Congress authorized
just five years ago.

So the truth of the matter is that funding has not merely flatlined and
then dropped by 7% from a high in 2010, but that funding overall is off
nearly $14% each and every year from what was promised four years.

The White House and Ambassador Goosby try to sugar-coat this defunding and
massive betrayal by pointing to President Obama's recent promise to treat
6 million PWAs by 2013 and to new efficiencies in treatment that have
lowered annual per patient treatment costs from $1100 to $335 (for the US
share of treatment costs, which is approximately 50% of total costs).
However, PEPFAR authorization was written so that newly achieved
efficiencies in treatment were supposed to be plowed back into treating
new patients, an issue with increased urgency because of findings that
early ARV treatment reduces the risk of transmission between partners by
nearly 96%.  

However, instead of having money poured back into treatment as a result of
hard-won treatment efficiencies, as mandated by law, we've seen
comparative defunding of treatment over the past two years and an
emasculation of the AIDS budget overall.  With even 50% of the $5.4 that
has been "stolen" by the Administration and Congress from PWAs around the
world, the US could treat over 8 million patients - 12 by 13!

Promising 6 million patients in treatment by 2013 was actually a
non-brainer for the President even though activists had to fight like hell
to get it.  6-by-13 can be accomplished even as President Obama deflects
$5.4 billion from global AIDS towards budget reductions and middle-class
voting perks. 

Even the Global Fund is only going to get 87.5% what it was promised
(presumably $3.5 billion of 4 million).  PEPFAR, on the other hand, slides
back big time and the waiting lines and cynicism in Africa and elsewhere
only grows.

This election year is going to have zero focus on global AIDS and the
funding fiasco unless we raise stink.  The US's cynical hosting of the
Int'l AIDS Conference will go unremarked unless we point out the US's
hypocrisy and deceit.  The 8 million patients whose treatment goes
unfunded will die.  This is more than a shame - it's an outrage.

Professor Brook K. Baker

Health GAP (Global Access Project)
Northeastern U. School of Law
Program on Human Rights and the Global Economy
400 Huntington Ave.
Boston, MA 02115 USA
Honorary Research Fellow, University of KwaZulu Natal, Durban, S. Africa
(w) 617-373-3217
(cell) 617-259-0760
(fax) 617-373-5056
b.baker at neu.edu

More information about the HEALTHGAP mailing list