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Letting AIDS Win

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A recent New York Times piece painted a stark picture for the future of Uganda and the global fight against AIDS. Despite the incredible achievements of U.S. foreign aid in combating the AIDS epidemic, advocates and health providers are worried that the US is turning away from this fight. Recent reports indicate that due to cutbacks in US aid, major clinics in Uganda are no longer providing AIDS drugs to those who need them most. Of the 500,000 people who need treatment in Uganda, only 200,000 are receiving it --- and 110,000 Ugandans are newly infected each year.

As the Obama Administration seeks to streamline US foreign aid, there is a disturbing trend to emphasize "cost effective interventions," including treatment for childhood diseases and maternal health, while flat-lining investments in "expensive" AIDS treatment. But given that the US spends less than 1 percent of its national budget on foreign aid in the first place, the "Sophie's choice" between two equally vulnerable and deserving populations is outrageous. While the cost of AIDS treatment is significantly higher than the cost of rehydration tablets to treat diarrhea or the cost of mosquito nets to prevent malaria, it is impossible to quantify the cost-benefit of saving a child from malaria when her mother dies from AIDS.

AIDS does not go away when we ignore it. In fact, just the opposite happens. There are currently 33 million people infected with HIV. Each year about a million people are newly infected. If we cut funding for AIDS programs now, future costs to stem the epidemic will only increase. Why? When people are turned away from treatment, the virus will spread. When families are forced to share AIDS drugs, incomplete treatment regimens may lead to drug-resistant strains. AIDS treatment alone was never the solution to the AIDS crisis. A larger commitment to prevention and ongoing education was always part of the strategic plan; a plan that requires money. If the US is committed to an efficient and sustainable approach to foreign aid, we must acknowledge that this comes with a price tag.

One key lesson learned from fighting the AIDS epidemic is that taking a holistic approach to strengthening health systems is critical if we expect to have any chance of stemming the AIDS crisis. We must address childhood diseases, maternal health, and other essential public health issues that will have a broad and far-reaching impact on development. Through PEPFAR funding, the US has invested in building strong health workforces and health systems that do much more than just address AIDS. Shifting our focus to cost-effective -- albeit vital -- programs at the expense of holistic strategies that include fighting AIDS is neither strategic nor morally sound.

American Jewish World Service funds grassroots organizations that address a wide range of interrelated health issues from HIV/AIDS to reproductive health to malnutrition. It is impossible for us to privilege our grantees addressing malnutrition over those battling HIV/AIDS. We cannot and must not take a mathematical "bigger bang for our buck" approach when we consider human lives. We must instead take a human rights approach that values every human life equally.

Many countries have shown great progress in the fight against AIDS, but as McNeil points out, most of Africa and other countries including Haiti, Guyana, and Cambodia are at extreme risk of seeing the AIDS epidemic rise to the level of the 1990s. These struggling countries will face disastrous consequences, and those countries that have made progress will experience major setbacks.

Instead of losing ground on one front in order to gain on another, we should explore creative methods to finance all the work that needs to be done by demanding a stronger commitment from global leaders and the US Congress. More broadly, we must support the Foreign Assistance Revitalization and Accountability Act (S. 1524) introduced in July 2009. The bill promotes global development, good governance, and a reduction of poverty and hunger. Specifically, the passage of S. 1524 will rebuild and strengthen strategic planning and human resources at USAID; address USAID operating expenses; increase accountability and transparency in US foreign assistance; and improve development coordination in the field.

Now is the time to recommit our foreign aid funding to ensure that 10, 20, 50 years from now, the recipients of our investments will still be alive and able to contribute to global society.