Is it possible that we soon will look back on the presidency of George W. Bush as the pinnacle of U.S. government efforts to eradicate global HIV/AIDS?
With the release this month of President Bush's memoir, and the full throttle assault on government spending voiced by the Tea Party and the members of Congress it helped elect, I have been reflecting on this question.
Whose policies do you prefer? Those of President Bush, who launched PEPFAR (the President's Emergency Plan for AIDS Relief) and was the first donor to the Global Fund to Fight AIDS, Tuberculosis and Malaria? Or those of President Obama, whose decisions on global health have come under scrutiny from all quarters, including the left flank of his party but who has taken a critical, positive stand for evidence-based prevention?
Ironically, PEPFAR -- and thus, President Bush -- may save President Obama's presidency. I'll explain why in a moment. But first, consider that since being launched in 2003, PEPFAR has provided antiretroviral therapy for approximately 2.4 million people in 30 countries, and has helped provide prevention and care services for millions more.
It quickly became the largest bilateral HIV/AIDS program in the world. As conceived, the program had its flaws, including a focus on prescribing abstinence at the expense of comprehensive sexuality education, as well as a ban on syringe exchange and a requirement that organizations that receive U.S. funds sign an anti-prostitution pledge.
However, millions of people received much needed services, treatment and care, and they thrived as PEPFAR's funding was consistently increased every year under President Bush and Congressional leadership. In terms of funding the fight against HIV/AIDS, President Bush exceeded all expectations. In his book, Bush writes that he hoped it "would serve as a medical version of the Marshall Plan."
President Obama has made other choices, in particular shifting funds from PEPFAR to his own Global Health Initiative (GHI). For instance, he has added only $155 million in his FY2011 request for PEPFAR -- well below the $1 billion per year in additional life saving spending he promised on the campaign trail.
It is important to note that President Obama did lift some of PEPFAR's onerous restrictions, thus expanding those receiving evidence-based prevention services. He has made other positive choices, as well - such as making the United States' first multi-year pledge to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which, while too low a dollar amount, sets the stage for future increases to this effective multilateral partner.
In any case, political realities changed this month. With newly elected Republicans demanding large cuts in funding overall, will President Obama gut PEPFAR and the Global Fund? Or is global HIV/AIDS an area for common ground -- a highly successful Republican-built program that a Democratic president can protect?
My hope is that the new Republican House leadership views PEPFAR as a critical program that needs to be preserved and even expanded, and sees the Global Fund as essential to the success of the GHI. My hope is that evidence-based prevention remains a core tenet of U.S. policy. While the U.S. deficit must be addressed, it should not be on the backs of the sick and vulnerable.
The HIV/AIDS pandemic is a humanitarian catastrophe with implications far beyond global health. It leads to poverty, malnutrition and the breakdown of families and communities. We have seen failed states in Africa that beget extraordinary violence and terrorism, which often arises when social structures collapse.
AIDS is an issue that should concern everyone across the political spectrum. Defense Secretary Gates, initially appointed by President Bush and Director of Central Intelligence under George H.W. Bush, repeatedly has underscored that development is a critical component of our national security policy.
In this time of deep political divisions in this country, combating HIV/AIDS is something we all can agree must be a priority. Both parties must reach across the aisle to work for the common good of saving lives.
I look forward to working with the new Congress to protect President Bush's legacy and help President Obama make a difference in the world.
Dr. Paul Zeitz is executive director of the Global AIDS Alliance.
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