World AIDS Day 2005

Yesterday was World AIDS day and President Bush touted some of the
early results of his $15bn, 5-year plan to combat AIDS in the
developing world, known as PEPFAR (The President’s Emergency Plan for AIDS Relief). That plan has put nearly 400,000 HIV+
positive people on antiretroviral therapy. The Bush Administration is
spending $2.8bn on global AIDS prevention and treatment this year
and has budgeted at $3.2bn for 2006 (interestingly enough, the U.S.
spends $17bn a year on domestic prevention and treatment efforts). Does
the Bush Administration deserve much credit for its global efforts? Is
the U.S. doing enough?

the U.S. is not doing enough, it may be doing more than others. I did a
talk yesterday for Princeton’s Student Global AIDS Campaign on
international donor responses to HIV/AIDS. It was a great opportunity
for me to get engaged on the issue as I gear up to write more about the
topic. I’ve been reviewing some of the data on donor responses to
HIV/AIDS. What’s pretty clear from recent studies is that there is a
big financing gap looming that may make it difficult to achieve goals
for prevention and for near universal access to treatment for AIDS
sufferers by 2010. The recent UNAIDS report
on financing needs suggests that in 2006 there is likely to be a
shortfall of $6bn of the total $14.9bn needed to ramp up global AIDS
programs. That funding gap is project to grow to $8.1bn in 2007 (out of
$18.1bn needed).

Whatever you think about the Bush
Administration, by most measures, the Bush Administration has
contributed far more to HIV/AIDS prevention and treatment than other
governments and previous administrations. A Kaiser Family Foundation
by Jennifer Kates found that the U.S. in 2004 contributed about 37.8%
of total government efforts to combat AIDS when you include bilateral
funding to governments and NGOs as well as contributions to the Global
Fund. Has the U.S. been doing its fair share? One measure of fair share
is for countries to contribute in line with their percentage of global
GDP. In 2004, the U.S. share was 28.69%. 2004 was not an anomaly. Between 2001 and 2005, UNAIDS estimates
the U.S. contributed 30.36% of total contributions to the Global
Fund which understates total U.S. contributions since much of its AIDS
assistance is channeled bilaterally. While all of the donors have
failed AIDS sufferers, the U.S. appears to be doing rather more than
others. Her paper finds that the UK and Canada both appear to be
contributing more than their share of rich country income while France,
Germany and Japan appeared to be lagging. It is pretty obvious Bush has
been able to secure far more funding for HIV/AIDS than President
Clinton ever could. Kates has another study
that shows U.S. contributions, unadjusted for inflation, for HIV/AIDS
dating back to the 1980’s. The peak for Clinton’s spending on global
aids was $360mn in 2000, and Bush’s spending in 2002 was $1.49bn even
before he announced the large emergency plan for HIV/AIDS.

Whether or not these funds actually are being spent wisely and having
the desired results remains to be seen. The Bush Administration has had
something of an ambivalent relationship with the Global Fund. While
U.S. officials have been actively engaged in creating and supporting
the Global Fund, the President has directed the bulk of his plan to
bilateral efforts. Congress is more willing to support the Global Fund,
and may even increase the President’s proposal to contribute $300mn in
2006 up to $600mn. In theory, PEPFAR and the Global Fund are supposed
to be complementary, but the degree of coordination on the ground may
be less than is desirable. I’ll elaborate on this in dynamic in future
posts, but a November 2005 Congressional Research Service report is suggestive:

Despite the emphasis on partnership, complementarity, and cooperation in
public statements, some suspect that U.S. officials are not entirely happy with the
Global Fund, and may see it as a rival that is drawing attention away from the
accomplishments of U.S. bilateral programs.   Some trace the suspected estrangement
to April 2002, when the Global Fund board chose Dr. Richard Feachem, a Briton, as
Executive Director, rather than an American candidate proposed by the United
States.  Others argue that the lead-up to the 2003 war in Iraq brought out sentiments
in the Administration that were unfriendly toward the United Nations and multilateral
organizations generally, and that this affected attitudes toward the Global Fund.
The tendency of the Administration to request less for the Global Fund than Congress
was willing to provide may be traced to these anti-multilateral points of view, some
believe.   At a September 2004 congressional staff briefing on the Global Fund,
officials were reportedly highly critical of Fund operations, causing observers to
doubt Administration statements of support.  However, even many of those who
have been skeptical of the degree of partnership between the Global Fund and
PEPFAR now acknowledge that there seems to be a new spirit of cooperation, as
symbolized in the Administration’s $300 million request for the  Fund in FY2006.
This new spirit has come late in the day, some argue, but is welcome nonetheless.
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One Response to “World AIDS Day 2005”

  1. The Global Fund is a great orgamnization doing great work in a number of countriies.
    When will begin to think about investing in community planning and design as a necessary response in combatting the pandemic? Architects, planners and policy makers owe it to us to be more forthright in their contribution to this area.

    ask how you can do more…..