The State of the Biden Administration’s Response to Global AIDS:  Twenty Years after Bush’s Historic SOTU Launch of PEPFAR, Biden Must Fulfill His Promise to End AIDS in Tonight’s State of the Union 

FOR IMMEDIATE RELEASE: February 7, 2023
Contact: Jessica Bassett, jessica@healthgap.org, 929-866-3929

The State of the Biden Administration’s Response to Global AIDS: 

Twenty Years after Bush’s Historic SOTU Launch of PEPFAR, Biden Must Fulfill His Promise to End AIDS in Tonight’s State of the Union 

Ahead of tonight’s State of the Union Address by President Biden, where he is expected to acknowledge the 20th anniversary of the President’s Emergency Plan for AIDS Relief (PEPFAR) with AIDS activist and rock star Bono attending as a guest of First Lady Dr. Jill Biden rather than honoring the leadership of a Black, HIV positive activist on national Black HIV awareness day, AIDS activists released a critique of the Biden administration’s mid-term record on global AIDS and a list of priorities the President should pursue to demonstrate commitment to his campaign promise to defeat HIV. 

Asia Russell, Executive Director of the Health Global Access Project (Health GAP), said: 

“Twenty years ago, George W. Bush delivered a State of the Union creating PEPFAR in response to massive mobilization led by people living with HIV from sub-Saharan Africa and around the world who were being denied access to life-saving HIV treatment. Two decades later, despite game-changing scientific advances that should make AIDS deaths and new HIV infections a thing of the past, the AIDS response is dangerously off track.  

“President Biden made a campaign pledge to defeat HIV and protect us from future pandemics. He has broken this promise. Under President Biden’s watch, the pace of HIV treatment scale-up in PEPFAR countries has slowed. PEPFAR has been flat-funded for more than a decade, forcing programs to ration prevention and treatment. Attacks in PEPFAR-supported countries are on the rise targeting sex workers, LGBTQ+ people, and people who use drugs–communities at far greater risk of HIV acquisition and AIDS-related death because of criminalization, discrimination, and bigotry. Fragile progress is being undermined as underfunded HIV programs have been expected to respond to COVID-19, Mpox, Ebola, and cholera. Without additional funding, health workers, or lab capacity, this has resulted in the diversion of HIV investments to other diseases, robbing Peter to pay Paul instead of scaling up health justice for all. 

“Bush announced a path in 2003 to combat AIDS during his State of the Union. Bush’s ambition–secured only thanks to the leadership of HIV-positive people–stands in sharp contrast to Biden’s lack of ambition and broken promises. 

“Tonight, Biden should keep his promise to the world and commit to fighting for $750 million in PEPFAR funding increases, a bold new PEPFAR initiative to defend the rights and freedoms of marginalized groups, and a commitment to break the stranglehold of drug company monopolies that still obstruct the rapid roll-out of game-changing treatment and prevention technologies for HIV–with dangerous replication COVID-19 and other pandemics. 

“It’s not enough for President Biden to celebrate 20 years of leadership against AIDS. He must also show his own.”

Tonight, President Biden should announce: 

• Immediate funding increases for PEPFAR, correcting the harms of 10 years of flat funding and putting the AIDS response back on track so the world achieves the global target of defeating AIDS as a public health threat by 2030. The President’s budget request to Congress, expected March 6, should include $5.14 billion in funding for PEPFAR. 
• A new strategic initiative for health justice for Key Populations (sex workers, people who use drugs, LGBTQ+ people, and people in confined settings) in PEPFAR-supported programs, saving lives and defending dignity and human rights as a cornerstone of the Biden administration’s AIDS response. This plan would scale up services provided for and led by Key Populations while boldly advancing strategies to dismantle colonial laws that criminalize Key Populations and undermine HIV treatment and prevention responses.  
• A plan to accelerate the delivery of game-changing, pandemic-defeating technology such as injectables for HIV prevention and treatment. Biden must start by leveraging the role of the U.S. government to accelerate equitable global access to CAB-LA, a long-acting injectable drug that is highly effective at preventing HIV infection but remains out of reach for communities most at risk of new infections thanks to ViiV’s monopoly and profiteering.
• Assurance that the federal government will, starting on May 31, replace funds for HIV treatment and prevention programs in any state, starting with Tennessee, whose governor has announced intent to reject federal HIV funding for prevention and treatment to guarantee life-saving programs have direct and uninterrupted access to alternative funding sources and individuals do not experience dangerous service gaps. 
• A commitment to ensure that everyone in the United States, regardless of insurance status, will have access to free COVID testing, vaccines, and antiviral therapy.
• A commitment for the U.S. to support compulsory licensing requests to expand access to Paxlovid to all middle-income countries. The drug can reduce the risk of severe Covid by 90 percent and the risk of Long COVID symptoms by 25% but remains out of reach for most middle-income countries, including nearly all of Latin America. And yet it is still nearly impossible to obtain in low- and middle-income countries due to restrictive intellectual property regimes. 
• Financial support for the mRNA vaccine technology hub in South Africa, starting with $100 million in funding now, to provide training and technical know-how to manufacturers in low-and middle-income countries.

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