President Barack Obama’s budget proposal released last week amassed a vast pool of criticism from the HIV/AIDS community, which is largely accusing the president not only of underfunding HIV/AIDS programs but also of going back on several campaign pledges.
The budget calls for $63 billion for a new six-year global-health initiative, which includes about $51 billion allocated to the President’s Emergency Plan for AIDS Relief, which funds international HIV/AIDS, tuberculosis and malaria causes.
During Obama’s campaign, he pledged to spend $50 billion on PEPFAR within five years, although the proposal now calls for a six-year program.
The other $12 billion included in the global-health initiative will fund other health causes, such as child and maternal health and the fight against tropical diseases, which Obama said are key areas of focus in presenting a unified approach to curbing global health threats.
“We will not be successful in our efforts to end deaths from AIDS, malaria and tuberculosis unless we do more to improve health systems around the world, focus our efforts on child and maternal health and ensure that best practices drive the funding for these programs,” Obama said last week.
Kaytee Riek, director of organizing at the Health Global Access Project, noted that Congress passed PEPFAR reauthorization legislation last year that allocated $48 billion over a five-year period, or about $9.6 billion a year. If the program is now extended to six years, Riek said the total funding should be closer to $57.6 billion, rather than the $51 billion allotted in the budget proposal.
“This $6.6-billion cut translates into less people on treatment and less people receiving assistance from programs,” Riek said.
While he was campaigning, Obama said he would increase PEPFAR funding by $1 billion per year, but last week’s proposal only amounted to a $366-million funding increase for the next fiscal year.
“We’re already hearing reports on the ground of people who were enrolled in programs and who were set to start treatment but no longer are going to be able to do so as a result of this budget,” Riek said. “You’re talking about lives lost.”
Of the money allocated for PEFPAR, about $900 million was allotted to the Global Fund to Fight AIDS, Tuberculosis and Malaria for fiscal year 2010. The Global Fund, which attracts, manages and disperses funding for HIV/AIDS, TB and malaria programs throughout the world, received the same amount of funding this past fiscal year.
“Next year the Global Fund has been flat-funded; not a single dollar more will go to the Global Fund, which means they’re going to have to start canceling routes of funding,” Riek said.
HIV/AIDS advocates were also awaiting last week’s proposal to see whether Obama would lift the longstanding ban on federal funding for needle-exchange programs, which he ultimately did not do.
White House spokesperson Ben LaBolt said Obama, who in the past has expressed support for removing the federal ban, did not write in such a change to the budget because he first wants to raise awareness about the merit of such a policy change.
“We have not removed the ban in our budget proposal because we want to work with Congress and the American public to build support for this change,” LaBolt said. “We are committed to doing this as part of a national HIV/AIDS strategy and are confident that we can build support for these scientifically based programs.”
LaBolt noted that in the past, federal budgets have been used to “litigate divisive issues and score political points” and that “President Obama decided not to play politics as usual with this budget and, while he remains committed to supporting the program, he wants to address that through the normal legislative process.”
In the proposal, however, Obama did suggest the near-elimination of federal funding for abstinence-only programs, directing that money instead to teen-prevention efforts.
Also in terms of domestic funding, for the first time in two years, the Centers for Disease Control and Prevention saw an increase in funding for its HIV/AIDS programs. The budget calls for $745 million for the CDC in fiscal year 2010, with an increase of about $53 million for its HIV/AIDS prevention and treatment efforts.
Additionally, the budget allocated an additional $54 million in funding for Ryan White CARE program, which seeks to bolster healthcare for those with HIV/AIDS, raising the total budget for the program to approximately $2.3 billion.
A coalition of LGBT and HIV/AIDS organizations including the Human Rights Campaign, AIDS Action and AIDS Institute, created a proposal last fall that suggested, however, that the president increase funding for the CDC’s HIV/AIDS programming by $877 million and Ryan White funding by $614.5 million.
Ronald Johnson, deputy director of AIDS Action, said in a statement last week that while he is pleased that Obama called for increased domestic HIV/AIDS funding, the dollar amounts are not sufficient.
“In the context of this budgetary environment, we think the president’s budget request represents a positive step and certainly is a departure from the previous administration’s budget request,” Johnson said. “But they are not enough to match the need, and we will certainly continue to press Congress to build on the president’s budget request to reach funding levels that are more responsive to the real needs.”
Kevin Burns, executive director of Philadelphia-based ActionAIDS, said, “The difference between the CARE Coalition’s request and what was actually in the president’s budget is really startling. The overarching goals of the president’s National AIDS Strategy — reducing HIV incidence, ensuring access to care and addressing dispiriting in outcomes for people of color and the LGBT community — are going to be really hard to achieve with this type of funding.”
Burns noted that the minimal funding increases for Ryan White could be partially attributed to the hope that the president’s plans for healthcare reform will unite the HIV/AIDS community.
“On Capitol Hill there is the political will to move healthcare reform forward, so hopefully some of these disparities will be taken care of with that, but now we’ll be coming from so far behind,” he said.
The budget also suggests a $50-million increase in funding for HIV/AIDS programs at the National Institutes of Health, upping its current budget of $3.05 billion to about $3.1 billion.
Funding is level, however, for the Department of Housing and Urban Development’s Housing Opportunities for People With AIDS program at $310 million.
This program recently granted local HIV/AIDS housing organization Calcutta House the second renewal of its three-year grant, which funds its Serenity Court housing program.
Matt Teter, executive director of Calcutta House, said the grant, which amounts to more than $819,000, represents a slight but much-needed increase from the last grant and is essential in continuing operations at Serenity Court.