In 2003 I travelled to Dar es Salaam, Tanzania, for the first time. Like most of the continent, Tanzania was staggering under the burden of a burgeoning AIDS epidemic. AIDS was still a death sentence.
I met women with HIV whose babies were born with HIV, even though drugs existed that could prevent this. Coffin makers dominated the markets and lined the streets. Virtually no one was receiving the life-saving antiretroviral drugs that had already transformed the AIDS crisis in the United States.
But a major change was looming. Earlier that year, the Republican-controlled House and Senate passed a bill authorizing funding to two critical new initiatives — the President’s Emergency Plan for AIDS Relief or PEPFAR (an initiative proposed by President George W. Bush), and the Global Fund to Fight AIDS, Tuberculosis and Malaria.
The U.S. contribution to these initiatives would grow to $6.81 billion per year in 2016, making the United States the single largest contributor to the global AIDS fight. Between 2004 and 2016, in Tanzania alone, U.S. investments put nearly 800,000 people on lifesaving treatment and reduced new HIV infections among children by more than 80 percent.
We are now at another fork in the road for the AIDS pandemic. President Donald Trump’s first budget proposal imperils the progress made over 13 years of PEPFAR and the Global Fund.
The budget outline made public last Monday could cut foreign assistance spending by as much as 37 percent — meaning fewer people on HIV treatment, more preventable deaths, and greater instability around the world.
The value and success of the U.S. government’s investments in the AIDS response are widely recognized by citizens and political leaders alike.
A 2015 poll conducted by the Kaiser Family Foundation showed that there is strong popular support for these programs, with 7 in 10 Americans believing that U.S. investment in global health was in their interest. Even Vice President Mike Pence, President Trump, and Secretary of State, Rex Tillerson have publicly voiced their support for PEPFAR and the Global Fund.
Indeed, the story of how U.S. investments helped transform the world’s HIV response is one that Americans can be proud of. The Global Fund has saved over 20 million lives and PEPFAR today supports 11.5 million people on HIV treatment, provides care and support to 6.2 million orphans and vulnerable children, and has ensured that 2 million babies were born HIV-free, around the globe.
Despite the proven impact of these investments, budgets are already stretched. In the midst of budget cuts and flat line funding under the Obama administration, PEPFAR worked hard to become even more efficient — still doubling the number of children on HIV treatment between 2014 and 2016. But our progress is fragile.
UNAIDS modeling shows that failure to increase investment in the HIV response will result in 17.6 million new infections and 10.8 million AIDS related deaths by 2030.
Some suggest the U.S. is already doing more than its fair share. According to the Kaiser Family Foundation poll, most Americans grossly overestimate the percentage of the federal budget spent on foreign aid — with an average estimated contribution of 26 percent.
While it’s true that the U.S. is the single largest contributor to the global HIV response, the U.S. ranks as the 20th most generous country in the world — contributing just 0.17 percent of its gross national income, while Sweden contributed 1.4 percent and the United Kingdom 0.7 percent.
In 2013, ten years after my first trip to Tanzania, I returned to Dar es Salaam to find a very different reality. Most people living with HIV that I met were hopeful about their future. There were fewer carpenters selling coffins on the side of the street. Still, the fight is far from over. Only half of Tanzanians living with HIV have access to the medicines they need.
The president’s budget could spell the reversal of over a decade of progress and put the world on track for a disastrous end to what has been an incredible story of transformation in the global AIDS response.
The good news is that Congress has the ultimate power to set the budget. Elected officials in the House and the Senate have a critical role in determining what Dar es Salaam will be like in 2023.
President Trump just threw down the gauntlet. It is up to the House and Senate to defend America’s proud legacy — and the lives of millions of people living abroad.