An AIDS-free generation

HIV/AIDS programs have seen funding cuts for the fourth year in a row.

By Lea Hoefer

Since the start of the global AIDS pandemic, an estimated 78 million people have contracted the disease, and approximately 39 million have died from AIDS-related causes. The disease has been devastating, not just in the number it has infected and killed, but also in the way it has struck down young and healthy adults. Economies were crippled as their productive workforce fell sick, leaving the old and the young to try and take care of each other. But all of this has been happening in slow motion, I realized when visiting Africa when I was younger. People take a long time to get sick, a long time to die, and yet during all of this time little is done to help. Finally, recognizing the threat that HIV/AIDS posed both to human health and to the stability of other nations, former president George W. Bush created the President’s Emergency Plan For AIDS Relief (PEPFAR) in 2003 in order to provide bilateral aid for HIV/AIDS treatment and prevention. Today, the United States also provides aid to multilateral programs like the Global Fund to Fight TB, HIV/AIDS, and Malaria (known as the Global Fund).

The U.S.’s efforts to fight HIV/AIDS have been greatly aided by research that has produced drugs that are more effective, have fewer side effects, cost as little as $140 a year, and lower transmission rates by 96%. What was once a death sentence has become, thanks to the right tools, a manageable chronic condition. Science has provided us the tools to end AIDS—and indeed, under the leadership of former Secretary of State Hillary Clinton, the United States created a blueprint for realizing this goal.

In Secretary Clinton’s own words, it is feasible that with widespread, evidence-based treatment and prevention programs, we will see a generation in which “…virtually no children are born with the virus. As these children become teenagers and adults, they are at far lower risk of becoming infected than they would be today thanks to a wide range of prevention tools, and if they do acquire HIV, they have access to treatment that helps prevent them from developing AIDS and passing the virus on to others.”

However, if we believe that an AIDS-free generation is not only possible, but also a goal worth striving for, then why have we seen funding for HIV/AIDS programs once again cut in this year’s national budget? Support for programs like the Global Fund and PEPFAR has not only flatlined over the past few years, but has also undergone $600 million in cuts since 2011. This year’s budget for global HIV/AIDS programs contains an additional $300 million cut from previous funding levels, due to legal restrictions that tie U.S. contributions to the Global Fund to those of other donor nations.

But the restrictions placed on donations to the Global Fund do not have to lead to an overall decrease in funding for global HIV/AIDS programs. The Republican-led House of Representatives has already moved to restore this funding to PEPFAR for the upcoming fiscal year. However, this important move will be for nothing if the Senate cannot also agree to restore the $300 million in its version of the appropriations bill.

When examined within the context of our national budget, this amount of money is minuscule—foreign aid comprises approximately 7/10 of one percent of national spending, with funding for global health a mere fraction of that 7/10. Yet, when this fraction fluctuates, it spells life or death for HIV patients in need of treatment around the world. The World AIDS Day (December 1) PEPFAR results report for 2013 revealed that during the course of the year, the United States directly supported antiretroviral therapy for 6.7 million people, prevented an estimated 240,000 babies from being infected with HIV at birth, and provided HIV testing and counseling for over 57 million people around the world. Successes like these can only be sustained if funding for these programs is likewise sustained. The PEPFAR Blueprint cites scaling up treatment programs as a key component of ending the AIDS pandemic, yet an estimate by the Foundation for AIDS Research Public Policy Director Chris Collins and Health Global Access Project Senior Policy Analyst Matthew Kavanagh predicts  that should PEPFAR continue to be affected by budget cuts, new enrollments in treatment programs will drop to their lowest level since PEPFAR’s creation in 2003.

As students and citizens, we have an important role to play in this fight. The world faces many public health challenges today, but the fight against HIV/AIDS remains critical, and even winnable. As students, our voices can play a powerful part in convincing our Senators to join the House in preventing cuts to PEPFAR. It takes minutes to make a phone call or write a letter asking your Senator to prevent a $300-million budget cut to global HIV/AIDS funding, but it has a real impact in showing them that public health is a priority. In the past, our own Senator Durbin has been a champion in the fight against AIDS as well as a bipartisan leader in efforts to increase funding for global health programs. There is no denying that he has recognized the impact that diseases like HIV/AIDS have both locally and internationally. We need to convince him to step up now.

As a medical student and future physician, I believe fighting HIV/AIDS is important from a humanistic standpoint, and critical from a public health standpoint. If we can’t muster the will to stop this pandemic, how can we expect to survive the next wave of emerging infectious diseases? (Clearly, we’re not doing too well with Ebola either.)

As Senator Durbin himself says on his website, “Helping other nations in the global fight against HIV/AIDS or to provide clean water, for example, are important moral choices that also strengthen our nation’s standing abroad as a global leader.” The moral choice that Durbin alludes to is now upon us.

Lea Hoefer is an M.D. candidate in the Pritzker School of Medicine.