Why Obama's Pulling Back From HIV/AIDS Funding

It turns out it's expensive to give lifesaving drugs to those 2.4 million people around the world who now rely on the American government to provide them. So, according to the Boston Globe, the Obama administration is thinking maybe we don't need to do so much giving out of AIDS medicine any more.

An article this month reports that the budget for PEPFAR, as the President's Emergency Plan for AIDS Relief is generally known, has swollen from $2.3 billion — when President Bush kicked it off in 2004 — to about $7 billion this year.

Obviously, that's a lot of money. But Obama knew it would be. According to the article, he pledged $1 billion in funding for the program during his campaign — but only asked Congress for $366 million, apparently because of the recession. That pushed patients onto the waiting list. The crude truth now seems to be that until already enrolled patients die, no one's moving off that waiting list.

A USAID source told the Globe that there was no official cap on the number of patients PEPFAR would take, but said the agency might consider one, if costs kept climbing. That, though, may not be the whole story. The Open Society Institute got its hands on a revealing letter the administration sent to Ugandan partners in October 2009, which says they should " expect to have a set flat-lined budget for ARV procurement," and that partners "who directly provide antiretroviral treatment should only enroll new ART patients if they are sure that these new patients can continue to be supported without a future increase in funding..."

OSI says that counts as a cap.

The letter continues: "In filling treatment slots that are made empty through attrition — i.e. deaths and loss to follow-up estimated at 12-30% annually — priority should be given to the sickest patients, eligible pregnant women, children, TB/HIV patients, and family members of persons on ART."

I quote the letter at length because there's another ugly truth here: Bureaucrats massage the human truth of their decisions with their language. When the letter tells a partner to "expect to have a set flat-lined budget for ARV procurement," what it's really saying is, "We're not giving you money to enroll new patients." And when it says partners can fill "treatment slots that are made empty through attrition," what it really means is, "When patients die, new ones can take their place. Your agency should make a plan for how to prioritize among the many people on that long waiting list."

It might not hurt to add, "Sorry about that."

And if you want to do something about it, OSI suggests signing an email petition set up by the International AIDS Society.

Photo Credit: jonrawlinson