THIS STORY HAS BEEN FORMATTED FOR EASY PRINTING
Joia Mukherjee

Continuing leadership in world AIDS fight

By Joia Mukherjee
March 9, 2009
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AS THE post-mortem is done on the Bush presidency, there is one remarkably bright spot in the relationship between the United States and the rest of the world - the program known as the President's Emergency Plan For AIDS Relief. In 2003, the Bush administration and Congress took the visionary step to commit an unprecedented level of resources for HIV prevention and care in the world's poorest and most heavily AIDS-burdened countries. The $15 billion, five-year initiative had the bold goals of treating 2 million people living with AIDS and preventing 7 million new infections by 2008.

By the end of last year, those goals had been surpassed. More than 2.1 million men, women, and children had received life-saving antiretroviral treatment through PEPFAR. The program had also supported a wide range of prevention initiatives, including community outreach programs that reached nearly 60 million people, distribution of more than 2.2 billion condoms, and programs to prevent mother-to-child transmission of HIV during nearly 16 million pregnancies. The United States has led the way for rich countries in the world to bring major resources to bear against the AIDS pandemic, both through the creation of PEPFAR and as the major contributor to the multilateral Global Fund to fight AIDS, tuberculosis, and malaria.

In 2008, in an effort led by then-Senator Joseph Biden, Congress renewed and expanded the commitment to PEPFAR. Because of their foresight and desire to make PEPFAR even more effective, then-Senators Biden and Barack Obama fought for and won legislation to renew the program for another five years, to increase its funding to $48 billion, and to extend its coverage to include tuberculosis and malaria, the training of health workers, nutrition programs, and expanded access to essential medicines.

Obama and Biden also campaigned on these promises even as the financial downturn loomed.

Now is the time to fully fund this expanded version of PEPFAR. In 2010, $9 billion is needed to enact all the reforms and expansion promised in PEPFAR's reauthorization and Obama and Biden's campaign. Additional funding is also needed for the Global Fund, which faces a shortfall of $5 billion through 2010. In order to meet our fair share and to provide significant leverage for other donor countries to fill the remaining gap, the United States should provide an additional $1 billion in supplemental funding this year and a commitment of $2.7 billion for 2010.

In this time of global economic crisis, it becomes even more imperative that we keep our promises to the world's poor, who are even more affected by this crisis than those in the developed world. Funding the expanded commitment to PEPFAR and the Global Fund is critical to fight the three diseases that collectively kill 6 million people each year and cost African nations an estimated $12 billion a year in lost productivity. If this economic crisis has taught us anything, it's that the fate of one economy can affect all of us. By investing in health in poor countries, the United States helps to stabilize and grow the world economy.

Congress and Obama made a promise to expand the US commitment by reauthorizing PEPFAR in 2008. Fulfilling this significant commitment to the health and development of the world will go a long way toward promoting economic stability and good will for the United States.

Dr. Joia Mukherjee is medical director of Partners In Health.

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