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AIDS Activists Criticize Obama Budget for HIV

African AIDS activists have joined their American counterparts in criticizing the level of funding for international HIV/AIDS programs included in U.S. president Barack Obama's proposed budget. The activists say President Obama has broken pledges he made as a candidate to increase funding, but others say the picture is more complicated.

The budget presented by U.S. president Barack Obama earlier this month includes $63 billion for global health programs over six years, $51 billion of that for AIDS, tuberculosis, and malaria. For the 2010 fiscal year, President Obama proposed $8.6 billion in spending on global health, up from $8.2 billion for the current year.

But many activists have criticized the proposed figures as falling far short of what President Obama proposed last year on the campaign trail. The Washington-based Global AIDS Alliance says that instead of the $50 billion over five years that President Obama had pledged for AIDS, tuberculosis, and malaria, the budget includes $51 billion, but spread over six years.

Speaking in Nairobi, Global AIDS Alliance Director Paul Zeitz, said that, on an annual basis, that translates into substantially less money than was promised for PEPFAR, the AIDS program started by President Obama's predecessor George Bush, and the Global Fund to fight AIDS, Tuberculosis, and Malaria.

"He asked for approximately $6 billion for the PEPFAR program and he asked for $900 million for the Global Fund," he said. "For him to have met his commitments on those two areas, he would have had to ask for at least $7.5 billion for PEPFAR and a $2.7 billion request for the Global Fund. So the PEPFAR was short by $1.5 billion and the Global Fund request was short by $1.8 billion."

According to the activists, an estimated one million people worldwide could go without AIDS treatment due to the shortfall, and some 2.9 million fewer women could receive assistance to prevent mother-to-child HIV transmission.

The coordinator for the Kenya Treatment Action Movement, James Kamau, said the United States' actions could influence those of other countries.

"In Kenya here we say when the lead sheep limps then it does not get the others to the pastures," said Kamau. "Now if he cuts back funding on the Global Fund then the rest of the people will follow suit"

But others in the public health field have greeted President Obama's budget more warmly. They say the budget reflects a concerted effort to expand the focus on other diseases like respiratory illnesses and diarrhea that are simpler and cheaper to treat, but that have been neglected by foreign aid programs. They say the budget also puts more of an emphasis on maternal health and improving infrastructure.

According to the president's defenders, these areas, which receive $12 billion over six years in the budget, represent an attempt to save as many lives as possible for the money available. The Bill and Melinda Gates Foundation and the singer and activist Bono, are among those who have welcomed the budget.

Additionally, the proposed budget may still be more money than the U.S. Congress is willing to spend on global health during an economic recession. The current budget resolution making its way through congress puts foreign aid spending for the 2010 fiscal year at $51 billion, almost $3 billion less than what the president asked for. A recent survey by the Kaiser Family Foundation found that over 70 percent of Americans are opposed to spending more on global health programs during the recession.

Kamau points out that African countries will eventually need to shoulder more of the burden for public health spending.

"We need the African governments to start walking the talk. They have pledged 15 percent of budget to health and they don't do it because they get bilateral funding like PEPFAR and others. Let's remember that this is an emergency fund, it's not a permanent fund, so we need to know how we are going to sustain this in the long term," said Kamau.

But the Global AIDS Alliance and its allies say that a global economic crisis is precisely the time when Western countries should be increasing, rather than decreasing, assistance for health programs. They note that many developing countries are already cutting back on public health programs due to their own deteriorating finances, and that if the United States and other donors do not increase their spending, that gap will go unfilled.