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Dr. Paul Zeitz Headshot

Obama's Report Card on World AIDS Day: 'C'

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People suffering and dying from AIDS deserve better than a mediocre response to their needs. And sadly, that is what they are getting from President Obama. Today -- World AIDS Day -- my own Global AIDS Alliance has given President Obama a mediocre 'C' grade for his 2010 response to the pandemic. That's an improvement over his D+ mark last year, but far short of superior grades of President George W. Bush.

President Obama did take praiseworthy actions in the fight against HIV/AIDS in 2010. What is missing is the bold audacity with which President Obama has embraced other issues

One positive but cautious step was the President's 3-year funding pledge in October to the Global Fund to Fight AIDS, Tuberculosis and Malaria. It represented the U.S.' first multi-year commitment, which will help sustain programs and aid the commitments of other nations that budget on a multi-year basis.

But the size of the U.S. pledge -- $4 billion over 3 years -- does not come close to meeting the $6 billion U.S. fair share. This contributed to the low level of pledges $5.3 billion below maintenance levels, forcing the Global Fund to scale-back its programs, rather than scale-up or maintain treatment levels.

Domestically, the same pattern emerged: strong policies with inadequate funding. President Obama introduced the watershed National HIV/AIDS Strategy -- a collaborative roadmap for policymakers and private groups to reduce HIV infections, bolster treatment and decrease HIV-related health disparities. But the Administration has severely underfunded AIDS Drug Assistance Programs (ADAP) for the poor, with more than 2,500 people now on waiting lists for medication.

This funding shortfall is particularly disturbing in light of last week's release of the UNAIDS 2010 Global AIDS Epidemic Report, which indicates the number of new infections declined globally to 2.6 million. However, 33.3 million people remain infected with HIV, with 1.8 million people dying of AIDS-related complications each year because just 35% of those who need ART receive it.

Yet President Obama -- who promised to spend $1 billion per year on the President's Emergency Plan for AIDS Relief -- added only $155 million in his FY2011 request for PEPFAR, instead shifting funds to his own Global Health Initiative (GHI). As a result, the Administration's newly released operational plan for PEPFAR includes funding cuts for 21 of 34 countries. This includes reductions in nearly every program, including $56 million from adult treatment services, $34 million from the ART budget and $13 million from counseling and testing. It includes a $135 million increase to fund management and operations.

Before us is a paradox. The world has demonstrated significant progress in preventing and treating HIV/AIDS. But now, severe funding cutbacks threaten such progress, including a virtual flat-line of U.S. funding. America made a promise to be at the forefront in the HIV/AIDS fight. Our integrity is at stake.

For President Obama to improve his HIV/AIDS report card in 2011, he must fulfill U.S. promises to fully fund PEPFAR and the Global Fund, and this will require him to build bipartisan support for PEPFAR, the Global Fund and GHI. Meantime, President Obama also must hold fast during the next Congress to one of his key AIDS successes: Lifting PEPFAR's most onerous restrictions, such as a Bush Administration focus on abstinence education and banning syringe exchange.

In my opinion, President Obama needs to show now that American policies are empathetic, smart and transcendent - not cold, stingy and small-minded.

Dr. Paul Zeitz is executive director of the Global AIDS Alliance