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June 1, 2007
PEP-FAR FROM ENOUGH
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Bush promises not kept — can Congress do better? |
President George Bush announced Wednesday that he'd ask Congress to provide $30 billion over the next five years for the President's Emergency Program for AIDS Relief (PEPFAR).
Though the funding increase drew broad news coverage and appreciative comments from PEPFAR contractors, Republicans and some global AIDS activist, others blasted the Bush PEPFAR plan for key failures:
- Treatment targets were dramatically reduced, leaving 1.5 million PLWHAs without treatment despite prior U.S. promises and per-year PEPFAR funding is essentially flat despite increased infections worldwide.
- Abstinence-until-marriage initiatives will continue to take up about seven percent of PEPFAR funding—that's $2.1 billion over the next five years—despite the initiatives' proven failure to stop the spread of HIV.
- Acknowledging the "catastrophic" shortage of health care workers in Africa, but failing to address the problem.
- "As the tide of HIV/AIDS rapidly rises, we are not even treading water," said Dr. Paul Zeitz of the Global AIDS Alliance. "This is not a plan for victory in the fight against AIDS."
Paul Davis of Health GAP agreed. "Downgrading a five-year program to get two million people on treatment to a ten-year program supporting only 2.5 million people demonstrates that the Bush administration is not serious about honoring the commitments we have made to the world community,” he said. "The real U.S. share of the cost of keeping the promise is at least $50 billion by 2013—that's what we need. The President's scale-back proposal must be rejected by Congress and the next President."
"Eighty percent of the women worldwide who are living with HIV contracted the virus from their husband or primary partner. It is clear that abstinence-until-marriage programs are failing them,” said Serra Sippel, deputy director of the Center for Health and Gender Equity.
$8 billion needed for health workers
Health GAP called on Bush to commit to continuing support for one-third of the people estimated to be in urgent clinical need of HIV treatment - a "fair share" proportion that will increase to at least four million people by 2014.
 | Bush ignores the need for HCWs in Africa. Will the WH08 candidates? |
According to advocates, in its second phase PEPFAR must urgently scale up its investments in training, retaining and supporting expanding numbers of doctors, nurses and community health workers, in order to meet existing targets and build toward new ones.
"There is a catastrophic shortage of health workers in Africa, and unless PEPFAR commits to spending new money to address this crisis, the U.S. will not be able to meet its treatment and prevention goals—or sustain its progress over the next phase of this program," said Asia Russell of Health GAP.
The group estimates that at least $8 billion in additional spending by the U.S. is needed to invest in training and retaining health professionals during the next four years of PEPFAR.
AIDS activists are pressing presidential candidates from both parties to commit to a landmark initiative to fund the health care workers needed to hit treatment goals and keep millions alive.
Activists also called on Congress to repeal ideologically- motivated provisions in the second phase of PEFPAR, such as the earmark of spending at least one-third of prevention funding on ineffective "abstinence only until marriage" education.
And they called for elimination of the wasteful program of FDA "tentative approval" for generic medicines. Although this process eventually resulted in procurement of generic medicines, it duplicates the efforts of the World Health Organization, primarily because of political objections by the Bush Administration (and their funders at PHARMA).
Health GAP has prepared a full set of recommendations for PEPFAR policy and funding you can download here.
Activists also criticized U.S. global AIDS policy leaders and Bush for dragging their feet in funding the nation's fair share of the funding needs of the Global Fund to Fight AIDS, Tuberculosis and Malaria, a critical complement to U.S. bilateral programs.
The Global Fund has announced a funding target of $6 to $8 billion by 2010, and Health GAP and other advocates have called on the U.S. to scale up its investments in the Global Fund to meet the target.
According to administration officials, Bush chose to make the PEPFAR announcement right before next week's G8 summit where he is likely to take criticism for his administration's positions on climate change, the war in Iraq and recent chaos at the World Bank.