Keeping Our Promise on AIDS

On Tuesday, June 9, the Senate Foreign Relations Committee held confirmation hearings for Dr. Eric Goosby to serve as Ambassador at Large and US Global AIDS Coordinator. That same day, nearly 6,000 people living with HIV around the world died—as they do every day—due to a lack of access to life-saving treatments.The stakes are high and the tasks at hand enormous. Dr. Goosby is well qualified to lead the nation's global AIDS efforts, and the Senate should act swiftly to confirm his nomination so that he can quickly bring the full measure of his expertise and experience to bear and provide needed leadership for the nation's extensive global HIV/AIDS portfolio.Dr. Goosby's confirmation and leadership come at an especially pivotal moment. President Obama recently released the outline for the US Global Health Initiative, and the Institute of Medicine published expert recommendations for action on global health. President Obama's vision brings a much-needed integrated approach to fighting diseases, improving health and strengthening health systems around the world.Disappointingly, however, his plan does not call for funding global AIDS programs at the levels called for in the recent reauthorization of the President's Emergency Plan for AIDS Relief (PEPFAR)—a reauthorization co-sponsored by then-Senator Obama. The lack of increased support threatens the further scale up of AIDS treatment and prevention efforts so desperately needed on the ground and called for in the new law.The US has the resources to keep its promise to scaling up HIV/AIDS treatment and prevention programs while at the same time strengthening its commitment to other critical global health initiatives. The administration and the Congress must commit to doing both.PEPFAR's successes are well-documented. More than three million people in sub-Saharan Africa are now receiving anti-HIV treatment and PEPFAR has also provided antiretrovirals for nearly 1.2 million HIV-positive pregnant women around the globe, allowing nearly 240,000 infants to be born HIV-free. A recent study in The Lancet highlighted PEPFAR's role in cutting the HIV/AIDS death toll from 2004 through 2007 by more than 10 percent in targeted African countries.Even with this progress, the demands of the HIV/AIDS epidemic in sub-Saharan Africa are still tremendous, especially among children who are only one third as likely to receive antiretroviral therapy as adults. In total, nearly 5 million of those living with HIV in sub-Saharan Africa who need treatment still do not have access to it. The vast majority of infected pregnant women still do not have access to treatment for themselves or to prevent transmission to their babies.After the initial successes of PEPFAR, the US promised to continue the scale up of HIV/AIDS treatment and prevention programs over the next five years. Stalling that scale-up is, as our Ugandan colleague and HIV treatment pioneer Dr. Peter Mugyenyi says, "a recipe for chaos." Millions are already on treatment and millions of others will become eligible in the years ahead. After urging people to get tested and enter care, providers would be forced to tell them there is no treatment available when they need it. Without adequate annual funding increases, patients will start to share doses or skip treatment all together. The result will be more drug-resistant strains of HIV and rising death rates. That is an unacceptable scenario and would be a tragic outcome of US leadership and investment in the global HIV/AIDS response.We still have time to prevent this course. Fulfilling our promise to scale up global AIDS programs would reflect our nation's deep belief in doing what is right for those in greatest need and at the same time move us closer to the international goal of universal access to HIV treatment and prevention.

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