Challenges and Limitations to President Bush’s Pledge of HIV and AIDS Funds

On Wednesday, May 30, President Bush called on Congress to reauthorize the President's Emergency Plan for AIDS Relief (PEPFAR) and to increase the U.S. commitment to global HIV and AIDS care, treatment, and prevention by $30 billion over the next five years. While this pledge could potentially save millions of lives, it includes restrictions that limit the effectiveness of PEPFAR’s mission of preventing and treating HIV and AIDS.  

While critics have been vocal about anticipated shortfalls in funding for care and treatment, they have been less outspoken about the inadequate level of HIV prevention funding. A United Nations policy paper, Intensifying HIV Prevention, asserts that “in the absence of a cure, prevention is the only hope of reversing the epidemic…. A comprehensive HIV prevention package could avert 29 million (or 63%) of the 45 million new infections expected to occur between 2002 and 2010.” Successful HIV treatment reinforces HIV prevention, and without treatment opportunities, prevention efforts can fail.

The current mandate that one-third of all U.S. HIV prevention funding be spent on abstinence-until-marriage programs is an enormous barrier to meeting the prevention needs of people at higher risk for HIV infection, including women and youth, sex workers, injecting drug users, and men who have sex with men. Another key limitation in the plan is in the meager funds available for evidence-based prevention interventions.

President Bush and other global leaders should increase resources for evidence-based HIV prevention efforts to prevent new infections. If the ultimate goal is universal access to prevention, care, and treatment services, combining treatment with effective prevention efforts could alleviate the resource needs for treatment, contribute to the sustainability of treatment and care programs, and save even more lives.