On January 28 of this year, President Bush, in his State of the Union address, promised $15 billion to fight global AIDS over the next five years. In the time since his speech, approximately 2.5 million people have died of AIDS-related illnesses, and much of the promised money has fallen victim to politics.
When the presidential budget came out for the fiscal year of 2004, the allocation for global AIDS funding was only $2 billion. The administration justifies "ramping up" funding over five years under the pretext that the absorptive capacity of the selected countries is limited. The U.N. estimates, however, indicate that the absorptive capacity is actually much greater than the money allocated by the U.S. And with the epidemic in full tilt, it makes no sense to limit spending in the short term, as infections today present considerable treatment costs in the future.
Fortunately, members of both the House and Senate including, notably, Sixth District Representative Henry Hyde (R-IL) and Senator Dick Durbin (D-IL), pushed for increased funding, ultimately raising the 2004 budget for global AIDS to $2.4 billion.
Unfortunately, the money did not escape Congress without two nasty provisions. The first, which passed the House on a strictly party-line vote, requires 33 percent of all prevention funds to go to "abstinence-before-marriage" education. Not only is this an example of inappropriate moralizing, but it's also incredibly poor public policy. The language of the amendment is breathtakingly vague as to what exactly the funding can be used for. With the strictest interpretation, the types of reforms that local organizations might have to undertake could be extremely disruptive. Additionally, abstinence programs don't make sense in the center of the epidemic, sub-Saharan Africa, where a significant proportion of infections take place within marriage. Married couples do not have the option of abstaining, so they must have access to accurate information and condoms in order to protect themselves.
Equally concerning were restrictions on the amount of money that could go to the Global Fund to Fight AIDS, Tuberculosis, and Malaria. This multilateral body has already surpassed expectations in its ability to identify partners and efficiently and accountably distribute funds. While it is still too early to evaluate program successes, it is clear that such a multilateral body has an important role to play in coordinating a global response. But the President's plan called for $1 billion for the Global Fund over five years, which is actually a decrease from 2002, when the U.S. sent $350 million. With a similar lack of leadership from other developed nations, the Fund now teeters on the edge of bankruptcy.
While the funding that was promised in the State of the Union was unexpectedly high, AIDS activists were most surprised by the price of $300 that the President quoted for a year's supply of anti-retroviral medication. This is the price for a year's worth of generic medicine, and activists hoped that the President's use of this number marked a watershed point in the administration's attitude towards intellectual property issues. But despite token efforts at increasing access, the U.S. has pursued international trade agreements with heavy patent protections, making access to generic medicines more difficult, even in the hardest-hit areas. On-patent drugs are simply not cheap enough to treat the 2 million people in desperate need that Bush vowed to treat 10 months ago.
To commemorate World AIDS Day on December 1, UNAIDS released summary statistics for 2003, as well as projections for the epidemic in the coming years. Despite universal acknowledgement that the AIDS epidemic is a crisis of monumental proportions and despite fine rhetoric from every level of government, the commitment is still too little and the outlook is heartbreakingly grim.
Soon the budget cycle for fiscal year 2005 will be underway, and the President and Congress will have another opportunity to fulfill the promises of last year's State of the Union address. As citizens and residents of the richest nation in the world, we must continue to press our government to give as much as possible to the global fight against this deadly scourge. President Bush said in January that, "This nation can lead the world in sparing innocent people from a plague of nature." It's time for our government to follow through.