U.S. Efforts to Fight Global HIV/AIDS

5.07

Emergency AIDS relief is a humanitarian, security and economic necessity. To win the fight against AIDS, the global community needs to scale up prevention, care, treatment, orphan care and research as well as efforts against the associated diseases of tuberculosis and malaria. The epidemic won’t stop itself, and the longer we delay, the more difficult and expensive it will become.

 

What are the needs?

The total funds needed to fight HIV/AIDS, TB and Malaria in 2007 are projected to reach $24.5 billion; if the U.S. provided 1/3 of this need and added its ongoing $350m in research, the total U.S. expenditure would reach $8.43b in 2007 and 9.59b in 2008.

 

Total Needs on HIV/AID, TB, Malaria	2007	2008
HIV/AIDS programmatic costs* (UNAIDS)	$18.1b	$21.1
Tuberculosis (Stop TB Alliance)	$3.5b	$3.8
Malaria (Roll Back Malaria, Global Fund)	$2.9b	$3.1
Total	$24.5b	$28.0
33% share of programmatic costs	$8.1b	$9.24
33% share of above plus $350m for research	$8.43	$9.59

 

How does the U.S. address those needs?

The U.S. relies upon both bilateral and multilateral mechanisms to fight HIV/AIDS globally. The President's Emergency Plan for AIDS Relief (PEPFAR) was announced by President Bush in his 2003 State of the Union address and is centered around a major increase in U.S. bilateral support for the fight against AIDS. The $15 billion, five-year initiative's goal is to reach 2 million people with life-saving antiretroviral drugs, prevent 7 million new infections and provide care to 10 million people affected by the disease by focusing the majority of new resources on 15 of the hardest-hit countries in Africa, the Caribbean and one in Asia¹. While scaling up bilateral programs in these focus countries, the initiative maintains existing programs in 96 other countries and also includes annual contributions to the Global Fund to Fight AIDS, TB and Malaria which operates in a total of 132 countries.

Funding
As announced in the State of the Union, the President's plan includes $15b to be spent over 5 years. The original plan was to begin with $2b in FY2004 and scale up by approximately $500m per year to reach $4b by FY2008. The vast majority of these annual increases would be directed to the "Global AIDS Initiative" line item in the budget through which funds for the bilateral programs in the 15 focus countries would be channeled. All other areas of the budget (ongoing HIV/AIDS, TB, Malaria programs and the contribution to the Global Fund) would essentially be level-funded.

• Through the FY2004 appropriations process, Congress added approximately $400m to the president's $2b request primarily to increase the U.S. contribution to the Global Fund from the $200m requested to $547m.
• In FY2005, the president requested a total of $2.8b. Congress again increased the contribution for the Global Fund from the $200m requested to $350m but did so by reducing the Global AIDS Initiative line item for the 15 focus countries, thereby leaving the total appropriation level at $2.8b.
• In FY2006, the President requested a total of $3.2b with $2.9b for bilateral programs and $300m for the Global Fund. Congress appropriated $3.4b including $2.9b for bilateral programs and boosting the Global Fund total to $544m.
• In FY2007 request, the President included a total of $4.26b, a net increase of $871m over FY2006 spending levels. Congress ultimately appropriated $4.8b including $4.1b for bilateral programs and $724m for the Global Fund.

 

U.S. Appropriations for Global HIV/AIDS, TB and Malaria
(In USD mns)	FInal FY06	Final FY07	FY2008 Potus Req
Global Aids Initiative (15 focus countries and other centrally-managed programs)	$1756.5	$2847.3	$3000.0
Global Fund to Fight AIDS, TB and Malaria	$544.5	$724.0	$300.0
Bilateral HIV/AIds, TB and Research	$986.8	$981.1	$948.1
Subtotal HIV/AIDS, TB and Research	$3287.8	$4552.4	$5380.4
Bilateral Malaria	$102.0	$256.9	$396.9
Total	$3389.7	$4809.3	$5777.3

Bilateral Programs-
The bilateral program can be broken down into two categories:

• Existing/ongoing bilateral programs for HIV/AIDS, TB and research: Through USAID and CDC, the U.S. provides funding for programs fighting these diseases in countries around the world. In addition, the U.S. channels resources to the CDC and NIH to conduct research. The baseline of resources for these ongoing activities has remained around $1b per year.
• New targeted bilateral funding for HIV/AIDS for 15 hard hit countries: The 15 focus country initiative builds off of and scales up existing mother-to-child transmission projects in each of these countries. The majority of new funds are channeled to these 15 countries through the Office of the Global AIDS Coordinator at the State Department. The initial appropriation in FY04 for these countries was $488m; in FY07 Congress appropriated $2.8b and in FY2008 the president requested $4.1b.

12 of the 15 Target Countries are in Africa

Botswana Cote d'Ivoire Ethiopia Kenya

Mozambique Nambia Nigeria Rwanda

South Africa Tanzania Uganda Zambia

In addition to the above HIV/AIDS accounts, malaria funding is now being scaled up through the President's Malaria Initiative which was announced in 2005. As such, bilateral malaria funding which was previously included as part of the broad HIV/AIDS, TB and Malaria effort is now accounted for separately.

 

Progress To Date
As of December 2007, U.S. bilateral programs have:

• Supported ARV treatment for approximately 1.4 million people
• Provided 6.7 million people with care, including more than 2.7 million orphans and vulnerable children
• Provided counseling and testing for nearly 13.6 million people
• Supported prevention of mother-to-child transmission services for over 10 million pregnancies

Multilateral Programs-

The U.S. also continues to support the Global Fund to Fight AIDS, TB and Malaria through which all donors can pool their resources and countries can then submit applications tailored to their needs. To date, the Fund has committed $9.8 billion to more than 520 programs in 136 countries. Of this total, $4.7 billion has been disbursed.

Some accomplishments of the Fund to date include:

• Supporting ARV treatment for more than 1.4 million people
• Provided voluntary counseling and testing for almost 17.8 million people
• Provided 3.3 million patients with treatment for TB
• Supplied 28 million people with ACT treatments for malaria
• Delivered 46 million insecticide-treated bed nets