On the day before World AIDS Day, the White House put out a statement saying “we reaffirm our ongoing commitment to end AIDS as a public health threat.” Advocates are waiting — and hoping for — that same sentiment to materialize into policy.
Despite President Trump’s encouraging language, his administration’s global HIV funding proposals would likely lead to millions of additional HIV infections and seriously imperil more than a decade of progress in turning back the global HIV/AIDS epidemic. In fact, a new report from ONE, a global advocacy organization working to address extreme poverty and preventable disease, warns that if White House funding cuts came to fruition, it would be akin to “surrender” in the global fight against HIV/AIDS.
Trump’s FY 2018 federal budget proposal calls for cutting $800 million from bilateral HIV/AIDS efforts — including the President’s Emergency Plan for AIDS Relief (PEPFAR) — and cutting $225 million from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Cuts like that, according to the ONE report “Red Ribbon or White Flag?: The Future of the U.S. Global AIDS Response,” would mean dramatically fewer people having access to treatment and a “reverse course in a successful drive to end this epidemic.”
Right now, members of the U.S. House and Senate look like a lifeline — leaders in both chambers have fully restored funding for PEPFAR and the Global Fund in their appropriations, said Sean Simons, press secretary at ONE. Still, Simons said, advocates are worried that longer-term, more sustainable funding for global HIV work is now at risk and they’re “raising the alarm” that years of life-saving progress are on the line. The ONE report cautioned that if Trump’s proposed budget cuts ever became a reality, it could mean nearly 300,000 deaths, more than 1.75 million new infections annually, and one-third fewer people added to treatment rolls each year. Three years of funding at proposed White House levels, the report stated, would put global progress back by nearly a decade.
Since President George W. Bush first launched PEPFAR in 2003, the program has saved 11 million lives and supports more than half of all people receiving treatment worldwide. Globally, according to the ONE report, the program has had a direct hand in helping more than 2 million babies avoid mother-to-child HIV transmission and contributed to a 47 percent decrease in AIDS-related deaths since 2003. For the first time, more than half of the world’s people living with HIV are getting life-saving treatment.
“It’s amazing how far we’ve come in such a relatively short time,” Simons told me. “When PEPFAR first launched, 5,000 people were dying of AIDS every single day, treatment options were almost nonexistent in many places, and people who could access treatment faced insane financial costs. At its core, PEPFAR brought hope to so many places.”
In a Nov. 30 release from the U.S. State Department, where PEPFAR is housed, officials presented new data that “(PEPFAR) has reached historic highs through its rapid acceleration of HIV prevention and treatment efforts, driven by transparent, accountable, and cost-effective investments.” In particular, officials reported that PEPFAR had achieved “landmark levels” in expanding access to treatment, now supporting more than 13 million men, women and children in receiving antiretrovirals. The program is also providing support for more than 6.4 million orphans, vulnerable children and caregivers affected by the epidemic. And for the first time, according to federal officials, PEPFAR data show significant declines in new HIV diagnoses among young girls and women.
Such promising numbers show it is possible to curb the HIV epidemic with sustained commitment and support as well as achieve global targets of reducing the number of new infections to 500,000 by 2020 (there were about 1.8 million new HIV infections in 2016). However, such progress likely wouldn’t survive the kind of proposed cuts coming out of the White House.
“Epidemiologically, it is simply not possible to stop the spread of the disease without increasing the number of people added to treatment and preventing a higher number of infections each year, especially in the hardest-hit countries,” said the report’s lead author Jenny Ottenhoff, director of global health policy at ONE, in a news release.
Simons told me: “It’s really hard to overstate just how devastating a cut like that would be to our efforts. We’re right at a point where we’re slowly getting ahead of the disease or at least keeping on pace with where we need to be. Taking our foot off the gas now would really throw off the timeline in which we can get our hands around this virus.”
And there’s “no replacement for U.S. leadership” on the global HIV/AIDS front, he said. In fact, the ONE report describes the U.S. role as “irreplaceable,” arguing that its investment and progress in HIV/AIDS prevention and treatment is one of America’s greatest global legacies in the last two decades.
But implementing the Trump budget cuts, according to the report, would likely lead to the first global increase in new HIV infections since 1995. Report authors Ottenhoff, Spencer Crawford, and Emily Huie write: “Over the past 15 years, Congress has invested billions of dollars in the epidemiological infrastructure – the supply chains, scientific expertise, and professional training – and treatment levels necessary to bring within reach the real opportunity to control the global AIDS epidemic. And it has been just that – an investment. Reducing funding for PEPFAR in the way that the Trump administration has proposed would mean abandoning that investment just as it is paying off.”
Just a couple days before World AIDS Day, observed Dec. 1, more than 35 global health and AIDS organizations — such as amFAR, the Infectious Diseases Society of America and Save the Children — wrote to leaders in Congress with “profound concern” for the potential direction of U.S. global HIV/AIDS efforts, calling on policymakers to at least support PEPFAR and the Global Fund at current funding levels.
“Today, the countries most impacted (by HIV/AIDS) are contributing more than ever before, but there’s still no replacement for U.S. leadership,” Simons told me. “The global fight against HIV/AIDS is winnable, but the U.S. must continue its leadership.”
For a copy of the “Red Ribbon or White Flag?” report, visit ONE.