HIV/AIDS advocates react to Obama's proposed global health initiative

Some HIV/AIDS advocates have voiced disappointment with the level of HIV/AIDS funding in President Obama's proposed $63 billion, six-year global health initiative, VOA News reports. According to VOA News, the advocates say that Obama has not met pledges he made as a presidential candidate, while other say that the "picture is more complicated."

According to the Global AIDS Alliance, Obama previously pledged to dedicate $50 billion over five years to HIV/AIDS, TB and malaria, but has instead proposed $51 billion over six years. GAA Executive Director Paul Zeitz said this proposal translates into significantly less annual funding for PEPFAR (Kilner, VOA News, 5/19). Zeitz said, "President Obama has a moral obligation to demonstrate global leadership on behalf of the poorest and most marginalized people of the world, especially in Africa," adding, "But by turning his back on those needs, the president is betraying the trust of tens of millions of people" (Pflanz, Daily Telegraph, 5/18).

Advocates estimate that the funding shortfall could result in about one million people going without HIV/AIDS treatment and about 2.9 million women going without treatment to prevent mother-to-child HIV transmission. James Kamau, coordinator for the Kenya Treatment Action Movement, said that one effect of Obama's proposal is that other donor countries could take similar actions, leading to additional cuts. "In Kenya here we say when the lead sheep limps then it does not get the others to the pastures," Kamau said, adding, "Now if [Obama] cuts back funding on the Global Fund, then the rest of the people will follow suit" (VOA News, 5/19).

Some have welcomed Obama's proposal, saying that it has expanded the focus of global health initiatives to include other health issues that can be treated at a low cost but have not received as much attention, VOA News reports. Obama's proposal includes $12 billion for these additional areas of focus, including more emphasis on maternal health and health infrastructure, according to VOA News.

According to VOA News, Obama's proposal might be more than Congress is willing to allocate during the economic crisis. The current budget resolution under consideration by Congress would allocate $51 billion for foreign aid in FY 2010, almost $3 billion less than what Obama requested (VOA News, 5/18).

African Government Spending on Health

Although African Union leaders in 2001 signed a declaration pledging to spend 15% of national budgets on public health programs, Kamau said that a majority of these governments have failed to meet this level of spending, with countries such as Botswana, Namibia and Zambia being the only exceptions, IRIN/PlusNews reports (IRIN/PlusNews, 5/20). He added, "We need the African governments to start walking the talk. They have pledged 15% of budget to health, and they don't do it because they get bilateral funding like PEPFAR and others." Kamau added that PEPFAR is "an emergency fund, it's not a permanent fund, so we need to know how we are going to sustain this in the long term" (VOA News, 5/18).

The Regional Network on Equity in Health said that African governments account for less than 1% of global health spending, although they make up 25% of the global disease burden, 60% of people living with HIV/AIDS worldwide, and the highest amount of people living with TB and malaria, according to IRIN/PlusNews. Still advocates urged the U.S. to re-evaluate its spending on global HIV programs, particularly short-term programs, IRIN/PlusNews reports. Zeitz said many advocates recognize that the U.S. is in the midst of a recession; however, he added that the U.S. "just spent one trillion dollars to bail out the banks on Wall Street, and the military budget has been increasing year on year ... it is really a question of priorities" (IRIN/PlusNews, 5/20).