10 Reasons why the U.S. should commit $15 billion to fight HIV/AIDS in Africa NOW
February 27, 2004
by Africa Action & TransAfrica Forum
Africa Action and TransAfrica Forum believe that current debates among U.S. policy-makers and advocacy groups about “appropriate” funding levels to fight AIDS in Africa are misplaced, and fail to represent the urgency of the crisis.
In his 2003 State of the Union address, President Bush promised $15 billion to meet the “severe and urgent crisis” of HIV/AIDS in Africa & the Caribbean. But instead of making this “emergency” money available immediately, the President proposed to wait one year and then spread it out over another five years (2004 – 2008), starting with minor increases in funding and projecting gradual increases in out years. In 2003, while the U.S. stalled, some two and a half million Africans died of AIDS.
The release of the “U.S. Five-Year Global HIV/AIDS Strategy” on February 23, 2003 comes 13 months after the President’s promise, and nearly half a year after the new U.S. Global AIDS Coordinator took office. It aspires to turn the tide of the global pandemic, but offers such low funding levels as to make this impossible. It also centers on the creation of a new bureaucracy that competes with and undermines the Global Fund to fight AIDS, Tuberculosis & Malaria.
We believe that the U.S. should provide at least $15 billion NOW to fight HIV/AIDS in Africa. The need is clear, as more than 6,000 Africans are dying of AIDS every day. And there are many ways in which this money can effectively be put to use immediately to save lives and prevent the further spread of the pandemic. We are concerned that the U.S.’ failure to provide the resources needed to support African efforts to defeat HIV/AIDS is evidence that racism is a determinant in U.S. foreign policy, and that a double standard exists that devalues Black lives. As Peter Piot, head of UNAIDS, has said of the AIDS pandemic’s concentration in Africa, “If this would have happened…with white people, the reaction would be different.”
Below are ten reasons why a commitment of at least $15 billion is required from the U.S. NOW to address the magnitude of the HIV/AIDS crisis in Africa.
1. Reverse the funding approach: For 20 years, the U.S. has failed to spend the money required to stem the devastating global spread of HIV/AIDS. As a result, more than 25 million lives have been lost, most of these in Africa – the world’s poorest continent and “ground zero” of the AIDS pandemic. Without an immediate and significant increase in funding, HIV/AIDS will continue to spread out of control. A major front-end investment is required from the U.S. to match the magnitude of this challenge and to help strengthen the capacity of African countries to respond. Rather than slowly ramping up in the future, while millions more lives are lost each year, the U.S. should spend at least $15 billion now to get the pandemic under control. A real commitment now will avoid exponential increases both in infection rates and in funding requirements later. In other words, the U.S. policy approach required now is the opposite of what is currently being debated in Washington.
2. Support the whole continent: President Bush’s “Emergency Plan” to fight HIV/AIDS in Africa and the Caribbean only includes 12 African countries. This selective U.S. approach not only ignores the rest of the African continent, which is also being devastated by the HIV/AIDS pandemic; it also precludes the more coherent and comprehensive response required to defeat this public health crisis. U.S. initiatives to fight AIDS in Africa should cover all 54 African countries. This will require a major increase over the limited, and inadequate, funding included in the current 12-country plan.
3. Fully fund the Global Fund: The Global Fund to fight AIDS, Tuberculosis and Malaria is the most crucial international vehicle to support poor countries’ efforts to fight the pandemic. Since 2002, Global Fund grants have been helping African countries to strengthen local public health infrastructure and to dramatically scale up efforts to prevent and treat these deadly diseases. Since its inception, the Global Fund has been forced to constrict its projections due to the absence of adequate funding from wealthy countries. Even at a minimal level of operation, the Global Fund still needs at least $1.56 billion for 2004 and $3.58 billion for 2005 in order to fund effective HIV/AIDS programs in Africa and globally. The U.S. should provide its fair share of at least one-third of this funding.
4. Treatment for All, not just for half: The World Health Organization (WHO) estimates that 6 million people living with HIV/AIDS in poor countries need immediate antiretroviral treatment. At the moment, less than 8% have access to this treatment – and in Africa, less than 2% of those in need have access to essential treatment. On World AIDS Day 2003, the WHO unveiled a global plan called the “3 by 5” initiative to provide antiretroviral treatment by 2005 to half of the 6 million people in poor countries who need it and will die without it. As of early 2004, there was still a funding shortfall of $5.5 billion over current contributions to reach that limited target. Reaching all of the 6 million people who need antiretroviral treatment is the only ethical goal and should be the urgent priority. This will cost at least twice as much. The U.S. should provide at least one-third of this funding.
5. Fully fund prevention that works: It is estimated that only 6% of people in Africa have access to voluntary counseling and testing, and that fewer than one-third of African youth have access to prevention programs. There is an urgent need for youth-focused prevention initiatives and for education programs that target vulnerable groups in African countries. At present, prevention education programs reach fewer than 1 in 12 sex workers and their clients. UNAIDS estimates that, by 2005, more than $1.5 billion will be needed annually to bring prevention programs to scale in Africa. The U.S. should ensure that at least this amount is made available for essential prevention programs. It should drop its insistence on an abstinence-only approach, which is a wrong-headed and ideologically driven priority that places fundamentalism over science and public health.
6. Protect the health of mothers and children: Sub-Saharan Africa accounts for about 90% of the 800,000 babies worldwide who acquire HIV each year. Prevention of Mother-to-Child transmission of HIV is an urgent need in African countries. A package of medical interventions can reduce by 50% or more the risk of transmission of HIV from mothers to their babies, but at present only 1% of pregnant African women who need them have access to such prevention measures. The U.S. should ensure sufficient funding for mother-to-child transmission prevention programs to meet the need in African countries. It should also ensure that HIV-positive mothers have access to essential treatment that can save their own lives and enable them to take care of their children.
7. Infrastructure – the most important investment: Turning the tide on AIDS in Africa requires addressing the limitations in public health infrastructure, eroded by years of World Bank and IMF structural adjustment programs. It also requires addressing the continent’s broader health crisis. The WHO Commission on Macroeconomics and Health reported in 2001 that a major increase in donor support was necessary to reduce the high mortality rates in poor countries and control diseases such as HIV/AIDS, malaria, and tuberculosis. The report estimated that donor support should be at least $27 billion per year by 2007. It stated that Africa should receive the largest proportion of this because e of its poverty and disease prevalence. In this context, the U.S. should prioritize upfront investment to help rehabilitate Africa’s public health care infrastructure. Arguments about Africa’s lack of “absorptive capacity” are largely false, as even countries’ existing capacities for treatment programs are being under-utilized. Moreover, funding itself will create capacity, which is usually a principal objective of any such program start-up.
8. Meet the Commitment to the Millennium Development Goals: In recent years, the Bush Administration has cut funding for child survival programs and for humanitarian and development assistance for African countries. Its implementation of the Global Gag Rule has forced the scaling back of health clinics and caused cutbacks in reproductive health services throughout Africa. These U.S. policies undermine African efforts to address the HIV/AIDS crisis and other health issues. All U.S. foreign assistance programs that impact public health in Africa should be funded to the maximum. The U.S. has committed to the Millennium Development Goals, which aim to reduce poverty, defeat HIV/AIDS and promote health in the world’s poorest regions. The Bush Administration’s new Millennium Challenge Account fails as a model to support human development in Africa. The U.S. should be willing to spend its fair share of the $40-$70 billion in additional assistance per year that is needed to meet these goals.
9. Meet the need for funding, at home and abroad: The United States spends more than $15 billion annually to combat AIDS domestically, where about 900,000 people are living with the disease. While domestic funding levels remain inadequate, and many people in this country – especially in communities of color – lack access to essential treatment and care, international funding levels are clearly also inadequate. The U.S. spends less than one-fifth of this amount to fight HIV/AIDS globally, and only a fraction of this in Africa, where almost 30 million people are living with the disease out of a worldwide total of 42 million. As it has become clear that the AIDS crisis in the U.S. disproportionately impacts African-American communities, funding for programs desperately needed by these communities has failed to keep up with the need. At the international level, the U.S. has consistently failed to commit its fair share of funding to fight HIV/AIDS in Africa. It should now provide at least the $15 billion promised to Africa to meet this urgent and growing crisis.
10. Focus on the real priority – AIDS is the greatest threat to human security: In his 2005 budget request, President Bush asked Congress for $400 billion for military defense. The Administration plans to spend $2.2 trillion on the military over the next five years, and is currently spending $4 billion per month in Iraq. While members of the Bush Administration have said that AIDS is a greater threat than terrorism, U.S. funding to fight HIV/AIDS remains completely inadequate. This reveals the skewed priorities of the Bush White House, as far as combating global threats is concerned. The United Nations states that, even with recent increases in global health spending, the world is not on track to provide even a minimal response to AIDS. The U.S. should be prepared to spend at least $15 billion now on a war against AIDS, which represents the truly greatest threat to human security in the world today.
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