AIDS Alert International: U.S. AIDS funding is smoke and mirrors, critics charge
AIDS Alert International: U.S. AIDS funding is smoke and mirrors, critics charge
Distribution could take more than a year
When President George W. Bush announced at his January State of the Union address that he would provide a five-year, $15 billion Emergency Plan for AIDS Relief worldwide, his efforts were lauded internationally.
However, when the fiscal year 2004 budget proposal was released later, AIDS activists called the Bush plan a funding shell game that shifts money from domestic areas to international programs.
"When the president spoke and released his proposal this was bombastic news — an enormous amount of funds dedicated for the pandemic," says Ana Oliveira, executive director of the Gay Men’s Health Crisis (GMHC) in New York City. "We were all very happy and surprised," she says.
But the good news didn’t last long. Several problems quickly emerged, including how the money will be distributed — over a five-year period — and how long it will take people suffering from the epidemic to benefit from the funding, Oliveira says.
The $15 billion is a five-year initiative that will help the most afflicted countries in Africa and the Caribbean, according to the Office of National AIDS Policy in Washington, DC.
Countries that will be the focus of the initiative include Botswana, Cote d’Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, and Zambia.
The United States proposes working with private groups within these countries to create a comprehensive system for diagnosing, preventing, and treating AIDS.
The Office of National AIDS Policy issued a statement, which said the money will help improve health care infrastructures, including laboratories, specialized doctors and nurses, and satellite clinics; and it will provide antiretroviral drugs and education on prevention of the disease.
"By truck and motorcycle, nurses and local healers will reach the farthest villages and farms to test for the disease and to deliver lifesaving drugs," said the statement issued by the Office of National AIDS Policy.
Also, the initiative’s goals are to prevent 7 million new infections, provide antiretroviral drugs to 2 million HIV-infected people, and help care for 10 million HIV-infected individuals and AIDS orphans. The first $2 billion in funding would be distributed in fiscal year 2004.
Redundant structure
But critics charge that the United States has created a large cumbersome vehicle for distributing international AIDS funds, when a much faster and more efficient vehicle already exists: the Global Fund to Fight AIDS, Tuberculosis and Malaria, based in Geneva.
The whole idea of the Global Fund was to create a vehicle for quickly distributing AIDS money. The Bush proposal, alternatively, will require congressional approval and then another 18 months minimum to work its way through federal bureaucracies, Oliveira says.
"The distribution of these funds over five years is a method that connects the funding for AIDS with governments that the U.S. is friendly with and supports," she says. "The government that the U.S. does not have direct contact or a relationship or is friendly with is not getting this aid."
Distributing a large sum of money in this fashion could destabilize certain regions, Oliveira contends.
"Take sub-Saharan Africa, for example," she says. "Small resources would go to one country, let’s say, and the country surrounding it wouldn’t necessarily get those resources."
For instance, Zimbabwe is not on the Bush administration’s list, although that nation is surrounded on three sides by countries that are on the list, and its own AIDS epidemic affects one in three adults, with more than 2.3 million children and adults living with HIV/AIDS. The epidemic has caused more than 200,000 deaths and has resulted in nearly 800,000 orphans, according to the most recent UNAIDS data.
Zimbabwe is saddled with an internationally unpopular leader, President Robert Mugabe, who caused an exodus of white farmers in the past few years and rigged the 2002 presidential election, according to the 2002 Central Intelligence Agency (CIA) World Factbook.
Other sub-Saharan nations could be excluded from receiving U.S. funds as well, including Zambia, Angola, Somalia, Malawi, and the Republic of Congo.
Threatening explosion
The proposed $15 billion also would not help nations with struggling economies in Eastern Europe, where the HIV epidemic is exploding, or in India and China where potential for a pandemic exists without powerful prevention efforts.
More than 100 physicians and other health care professionals in the United States wrote Bush on Jan. 22, 2003, urging a sensible approach to funding HIV/AIDS programs internationally. The letter stated, "When you took office, experts grossly underestimated how quickly the pandemic would spread. Now we know that the disease threatens to explode in the world’s most populous nations: 50 to 75 million people could be infected by 2010 in China, India, Russia, Nigeria, and Ethiopia; and it continues to reach record levels in Southern Africa."
An unequal distribution of AIDS money could result in problems in immigration, networks, and destabilization, Oliveira says.
Had the same money been placed in the Global Fund, it would have been distributed to those in need who applied through grants, and it would have been free of bureaucratic red tape and political favoritism obstacles, she explains.
"The Bush administration is not being a team player with other nations to collectively resolve this enormous plague," Oliveira says. "It’s a plague that requires global humanity response."
Other AIDS groups also criticize the administration for not putting the $15 billion in the global AIDS fund, where it could be used quickly and fairly to ease suffering and increase prevention efforts.
"The president’s budget included almost nothing for the Global Fund to Fight AIDS, TB, and Malaria," says Paul Davis, director of U.S. governmental relations for Health GAP Coalition in Philadelphia.
"He pledges $200 million a year for the next five years, and the fund needs $1.8 billion by 2004, or else it will be bankrupt and not able to fund a new round of grants coming later this year," he says. "The president is putting chump change for the Global Fund, but giving money to a bilateral initiative."
AIDS activists want the United States to donate an additional $10 billion to the Global Fund, but that is an unrealistic expectation, Davis says. Meantime, the Global Fund is struggling to fund the grants already approved, he adds.
Richard Feachem, MD, executive director of the Global Fund, told the fund’s board on Jan. 29 in Geneva, that while the Global Fund was fully funded through a second round of grant applications, it had no funding for the third round.
Since the fund’s policy was to cover grant agreements by cash and this pertains to the first two years of each five-year program, then the fund will run out of money, Feachem told the board.
"The Global Fund needs $6.4 billion in 2003 and 2004; so far, we have $1.2 billion pledged," he said in his speech. "Eighty percent of our fundraising is ahead of us."
The world’s wealthiest nations must step forward to support the fund, Feachem said. "In this context, we are pleased to hear President Bush’s commitment . . . to the fight against HIV/AIDS and to the undertaking to provide additional funds to the tune of $1 billion to the Global Fund beginning in 2004."
Gag rules, etc.
The Bush administration appears to be intent on keeping control over how most of the international AIDS money is spent and to whom it is distributed, Davis and Oliveira say.
For example, there are policy attachments to the international funding, such as gag rules prohibiting the money from going to organizations or clinics that include a mention of abortion in reproduction counseling, even if the U.S. money doesn’t fund that specific educational activity. The Bush administration also seeks to promote abstinence education when that is a poor HIV prevention strategy, Oliveira says.
"The money is attached to many policies detrimental to HIV prevention," she says.
"So on the global scene, the money is not that much money; it’s spread over a significant period of time, and it’s encumbered with restrictions," Oliveira says. "The money is strategically connected to alliances of the United States, and it will create instabilities."
President Bush’s proposal for increased funding for international AIDS initiatives may give the appearance of an administration that is friendly to AIDS causes, but this view is belied by the FY 2004 budget numbers, says Scott Brawley, director of public policy at AIDS Action in Washington, DC.
Funding offsets
While there is a $50 million increase in proposed spending for global HIV/AIDS programs in the FY 2004 budget, that increase partially is offset by a proposed $858,000 decrease in HIV money targeted for the Centers of Disease Control and Prevention in Atlanta, and cuts in programs targeting sexually transmitted diseases, and tuberculosis.
"We certainly recognize that the United States has to be part of a global response to HIV/AIDS; however, we’re concerned that domestic programs are being cut for HIV prevention, especially in a time when we have seen rising infections and rising STD infections," Brawley points out.
The Bush administration previously set a goal of a 50% reduction in new HIV infections in the United States by 2006.
"If you are taking away money to do prevention activities or not adding new money, then you’re shooting in the dark on this plan," Brawley says.
"And so the message is that the federal government is saying, We have this very lofty goal, but we’re not funding it,’" he adds.
Another problem with the FY 2004 budget’s immediate increase in international HIV funding is that there is no way to know how it will be spent and where it will be sent, he says.
"We have heard that the $50 million primarily will be sent to programs unilaterally, directly to programs or governments," Brawley notes. "So the administration is trying to hand-select the places where they want this money to go to."
When President George W. Bush announced at his January State of the Union address that he would provide a five-year, $15 billion Emergency Plan for AIDS Relief worldwide, his efforts were lauded internationally.Subscribe Now for Access
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