The Blueprint for an AIDS-Free Generation released by Secretary of State Hillary Clinton in November 2012 makes a bold declaration: We are at a tipping point in this most devastating pandemic of our time. By scaling up core, effective interventions, HIV infection and death rates can be brought down steadily in the coming years, and in relatively short order the costs will begin to recede as well.
There are many reports on the topic of global health. This one deserves to be read and acted on — and funded. If you don’t read the whole report, look at the pictures. Four graphs in the Blueprint are based on mathematical modeling of the distinctly different epidemics in Cambodia, Kenya, Uganda and Zambia. In each case, as AIDS treatment reaches people earlier in the course of disease, and as part of a combination of proven interventions, HIV incidence falls more rapidly. A separate graph, for Uganda, shows the dynamic effect of scaled-up services leading to reduced resource needs within just a few years. The same progress is possible in the U.S. epidemic, where some jurisdictions that have expanded coverage of AIDS-related services have seen declining HIV infection rates.
The Blueprint could be a road map for accelerating the end of the global AIDS epidemic. Or it could be a political document that showed us what could have been accomplished, while instead we resigned ourselves to the devastation of AIDS for decades to come.
The outcome will be determined by the actions of Congress and the White House in the coming weeks. Will budget sequestration go into effect in early March, slashing global health along with other discretionary spending? Will we maintain critical investments in research to find a cure and a vaccine? And will the President’s fiscal year 2014 budget proposal, expected by March, ask for increased funding for PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria?
The strategic vision of the Blueprint cannot survive a major cut to PEPFAR, the popular and enormously successful President’s Emergency Plan for AIDS Relief initiated by President George W. Bush. The Blueprint makes the business case for investment now: not treading water, but more rapidly scaling up the interventions that we know work. Doing so will advance global health more broadly. A recent study showed that investments in PEPFAR improved the overall strength of health systems and increased life expectancy in recipient countries.
For President Obama, this is a legacy issue. On domestic AIDS, the president has demonstrated great leadership with passage of the Affordable Care Act and creation of the National HIV/AIDS Strategy. On the global epidemic, the president’s Administration has accelerated scale up of effective services. With full implementation of the Blueprint, he can be the president who drove AIDS toward its end.
Leadership is needed from Congress, too. PEPFAR is the premier example of a bipartisan program at a time when those are hard to come by. Congress should remember that foreign aid is investment in global good will and stability on the cheap. As Senator Lindsey Graham said about foreign aid in volatile areas of the world, "The way I look at it is, it’s national security insurance we’re buying."
U.S. spending on global health is only about one quarter of one percent of the federal budget. You can’t solve the federal debt problem by slashing global health funding, but you can do enormous damage to millions of children and adults and squander terrific opportunities in the process.
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