President George W. Bush seems committed to battling the AIDS pandemic in developing nations but seems to be blind to the epidemic in his own back yard. The president has called on Congress to spend $30 Billion to combat AIDS globally over the next five years. This is doubles the amount of money Mr. Bush pledged in 2003 when he launched a five-year, $15 billion program to support treatment, prevention and care in developing countries. Simultaneously the Bush administration has kept domestic funding on HIV/AIDS care through Ryan White programs at the same level that existed in 2001 while the number of new infections in this country has continued to increase predominantly among the poor and people of color.
According to the “New York Times” with Congressional add-ons, the total for this global initiative through 2008 will actually exceed $18 billion, by far the largest amount committed by any nation. The program has already provided treatment for some 1.1 million people in 15 countries and prevented millions of new infections, by administration estimates.
Now, with the first five-year program set to expire next year, the president has proposed a five-year extension with almost twice the financing — $30 billion over fiscal years 2009 to 2013. The administration estimates that this, when added to the first five-year effort, would bring the total number of people treated to 2.5 million people, prevent 12 million new infections and provide care for more than 12 million people.
This funding is vital and is an important commitment to fighting the global pandemic. It is clear that Mr. Bush has his own motives for this initiative. AIDS was not a signature issue for Mr. Bush when he ran for office in 2000. But it has become one in part because the Christian conservatives who make up his political base have embraced the cause of AIDS outside of this country (the populations affected by HIV/AIDS in this country are not favorites of the Christian conservatives), and in part because Mr. Bush wants to build a legacy for his presidency and a more compassionate image abroad to counter international criticism of his policies in the wake of the Sept. 11, 2001, attacks. It is not by accident that the announcement of the ramped up funding comes just before Mr. Bush attends the G-8 summit.
Whatever Mr. Bush’s motives are, the initiative is needed and his support is welcome. However even with this wonderful support, the administration has absurd regulations for accessing funds that are based on a sense of “conservative morality” and not science. The president’s program remains burdened by restrictions requiring that up to 7 percent of the funds be spent on abstinence programs and by Congressional restrictions against providing clean needles to injecting addicts.
While these efforts are vital, Mr. Bush’s record on domestic funding for care and treatment has been shameful. For example – in my city, San Francisco, federal AIDS funds have been slashed by more than $8 million in FY 07 (a 34% reduction). The epidemic has not abated in San Francisco- in fact more people are living with HIV/AIDS in the city than ever before. Thankfully people are living longer but new infections are still occurring so the overall population of people living with HIV/AIDS continues to grow. The needs of people for medical care, drugs and the services needed to ensure that they have the support required so they can remain in care has not decreased but has grown; and this growth has been primarily among people with the most severe needs and with the least income.
HIV/AIDS impacts many areas of the country- many of them relatively new to dealing with the epidemic at a kaeger scale. This past year alone Indianapolis, Baton Rouge, Charlotte, Memphis, and Nashville have been added to the existing 51 local jurisdictions eligible for Part A (aka Title I) funds. It is clear that the need for care and treatment has not decreased or even remained level- it has increased. Yet the Bush administration has shamefully kept funding flat.
The Bush administration’s actions have pitted city against city, state against state and sometimes cities against their own states. By keeping the pot of funding at an unacceptably low level the Bush administration has put AIDS advocates on a desert island with insufficient food and water- causing friction between jurisdictions for this critical funding to serve those people living with HIV/AIDS with the greatest need. No one wants one part of the country to get less due to the needs of another, but with scarce resources everyone is scrambling for that one tiny morsel. The Bush administration has created this difficult environment by not allowing funding to keep pace with the increase in numbers of people needing services.
Mr. Bush administration has created an untenable situation for many in the AIDS community with his support for a global initiative while ignoring the problem at home. There is not one person that I know who works on domestic HIV/AIDS issues or one person I know that is living with HIV/AIDS that is not horrified by the toll that the pandemic has taken – and continues to take- on the developing world especially sub-Saharan Africa and who doesn’t believe that we should commit huge amounts of resources to that battle. But there is anger among many in the community that there is a hot white light cast on HIV/AIDS outside of this country and a flickering candle barely illuminates the epidemic within our own boarders.
Last night I attended a “Town Hall” meeting in San Francisco that focused on the federal cuts the city (as well as cuts that impact Marin County and San Mateo County) has sustained and what strategies the city can take to ensure that vital services are not closed. The anger was palpable and understandable. People spoke eloquently about how many of the services that could potentially be cut literally saved their lives. It was quite clear through these personal testimonies that food, shelter, substance abuse services, mental health services are all vital components of health care. Health care cannot be viewed as merely seeing a doctor and getting prescription drugs. These “wrap around” services are vital components of the continuum of care for people living with HIV/AIDS and if you disturb one card in this house of cards, they all come down.
Should Americans living with HIV/AIDS begrudge the money being sent abroad? No – we shouldn’t and mostly I don’t think that we do. But the anger of many about these funds being sent abroad when we haven’t “cleaned our own yard” is understandable.
The answer is simple really- more money needs to be spent battling AIDS both domestically and globally.
It is unfair and immoral for the Bush administration to put us in the situation where people living with HIV/AIDS are fighting over a crumb that will never be enough.