My refusal to cheer along may seem churlish, to say the least. After all, many more Africans are receiving AIDS treatment than when I worked there, and much of this is thanks to Bush administration programs. Globally, more than 1 million people are benefiting from treatment because of U.S. assistance. And, last month, President Bush made headlines when he announced a proposal to double U.S. spending on global AIDS to $30 billion between 2009 and 2013.
But let's take a closer look at the proposal. The fine print shows that Bush is really just extending AIDS funding at its current level for the next five years. We're now allocating about $5.4 billion a year, and if we just stayed on that trajectory from 2009 through 2013, it would total about $27 billion. The president's "doubling" claim is based on an old 2003 pledge to spend $15 billion from 2004 through 2008.
In other words, what Bono — who is often quoted as an expert on global health — called "great news" patently isn't. Belatedly, some saw their mistake, with the New York Times editorializing last week that Bush's proposal amounted to only "a slight increase."
Extending U.S. funding is the right thing to do, but it will be catastrophic if Congress doesn't provide a much more substantial increase as well.
The need for effectively targeted U.S. assistance is growing, not leveling off. In Zambia, for instance, 17% of the population is living with HIV, and there is a major tuberculosis threat as well, including extremely drug-resistant strains. Funding for TB treatment is lumped in with the AIDS budget, and countries in Asia as well as Africa need much more help tackling this deadly infection — not only to protect their own populations but to lower the risk of its spread to other countries.
Leveling off funding also makes a mockery of America's global leadership. The fight against AIDS is now geared toward one overarching, U.S.-endorsed goal: universal access to all AIDS-related services by 2010. Of course, similar targets have been set, and missed, in the past. But in the post-9/11 world, promises to poor countries have taken on a new seriousness. It will no longer do for wealthy countries to issue vague excuses when the deadline arrives.
There is a way the U.S. could leverage a global response to meet this 2010 goal. Each year, a portion of U.S. HIV/AIDS funds are given to the Global Fund to Fight AIDS, Tuberculosis and Malaria, an international public/private partnership. And each dollar the U.S. contributes is matched by $2 from other countries.
The Bush administration recently signed on to a plan to dramatically increase how much money the Global Fund hands out each year. But when it came time for the United States to cough up its share, the tone changed.
Last week, as the House of Representatives was debating the foreign aid bill, the president sent a "statement of administration policy" to dissuade Congress from increasing America's payment into the Global Fund. So, while the first lady is visiting a program in Mozambique that depends on money from the fund, her husband is working to limit U.S. contributions.
Perhaps the next president can go beyond PR spin and actually help the world get ahead of HIV/AIDS and other health crises. My organization, the Global AIDS Alliance, has joined health experts and African religious leaders to lay out for the presidential candidates a detailed, 10-point plan on strengthening health systems and fighting AIDS. It calls for a minimum of $50 billion in spending from 2009 to 2013, including full allocations to the Global Fund.
Our appeal may succeed. Some candidates already are thinking boldly about repairing America's international standing through expanded foreign assistance. But that noble project will falter unless candidates base their proposals not on their public relations value but on what is actually needed to win the battle against disease.