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Turn Frustration into Action: Ramp up Efforts on Global Health

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Written with Erin Hohlfelder:

It's easy, and perhaps justified, to feel frustration after reading the pieces on HIV/AIDS in this week's New York Times. Despite the huge growth in funding for HIV/AIDS in recent years -- driven by a coalition of bipartisan politicos, grassroots advocates, philanthropists, and celebrities -- our efforts have not been enough, and the goal of universal access to AIDS treatment, prevention, and care remains unrealized.

Yet if we look at where we are today, major progress has been achieved. In 2002, before PEPFAR was announced and the Global Fund was established, there were only 50,000 people on antiretrovirals, and many doubted that widespread distribution of treatment was even feasible. Today, through leadership from the United States, the G8, and some African countries, that number is more than 4 million globally, including more than 3 million in Africa. The success of these investments is tangible; anyone who has traveled through the developing world can see what progress looks like in the millions of people who are alive today and who are grateful for our investments.

We've anticipated for some time that the spike in political will for AIDS funding would not last forever. Also, experts have been saying for years that leading aggressive treatment efforts without equally rigorous prevention programs to match would become unsustainable. These worries and warnings are now becoming reality. The financial crisis is at least partly to blame. Budget crunches globally -- particularly in the US and across Europe -- have made it really difficult to find the same big increases for global health programs like PEPFAR and the Global Fund that we've grown accustomed to and have needed over the last few years. The Global Fund -- the world's largest provider of tuberculosis and malaria services to the poor and the second largest of HIV/AIDS services -- is currently facing a financial crisis as it struggles to attract enough investment from donors to continue funding programs that already exist.

The articles also highlight other factors that have perhaps collectively slowed the momentum around the AIDS fight. The Obama Administration, through its Global Health Initiative, has advocated for a prioritization of new global health funding for cost-effective interventions around maternal and child health, malaria, and neglected tropical diseases. This is not inherently wrong, and in fact many of those areas have long been overlooked and underfunded during the period when AIDS funding grew. However, AIDS is not "done," and it requires continued scaling up of funding for both prevention and treatment efforts. AIDS is called a crisis for a reason: without continued increases in funding, people will die.

Some African governments also need to look in the mirror (and their back pockets) before blaming donors for a lack of funding. Two of the countries mentioned in McNeil's articles -- Uganda and Kenya -- have been plagued by corruption scandals. Our global health programs can only succeed if the governments are accountable for investments and penalized if they misuse those investments. And many of these programs have established and been praised for very strong accountability mechanisms. The problem is, of course, that those who suffer as a result of corruption and the penalties that come with it are not the government officials who try to misuse the money, but poor people who need medicine to stay alive. "Improved governance" is not just about better-functioning bureaucracies; it's also about creating an environment in which donors can trust that their money will be used (well) to save millions more lives.

In spite of all these obstacles, we believe resolutely that the fight against AIDS is one that we can win. But at the end of the day, we all know that doing so requires bold new investments. That's what drives our current campaign at ONE to ensure that there aren't cuts to President Obama's budget request, particularly to his international affairs account -- from which AIDS, maternal child health, and other global health money flows. When we read the articles, it's easy to wring our hands and think "how could we let this happen?" But proposed cuts to the international affairs budget (see Conrad, Kent) pit global health programs that are equally as vital against each other for funding -- a true Sophie's choice when we think about saving lives across the developing world.

We take this these New York Times articles as a rallying cry. Your voices -- our voices -- have become even more important. We must spread the word that investments in global health work; now is not the time to walk away.

Josh Lozman and Erin Hohlfelder, ONE.org