US government budget cuts jeopardize goal to end AIDS by 2030

The Alliance notes with real concern the decision by the United States government to cut HIV spending as part of a wider reduction in US overseas aid for global health.

The cuts represent a ‘cliff edge’ $1 billion cut in HIV spending.

In total, $2.2 billion (-26%) will be cut, reducing the budget for global health assistance from $8.7 billion to $6.4 billion, the lowest level of funding since 2008 according to analysis by the Kaiser Family Foundation.

The new budget includes an overall cut to PEPFAR funding for bilateral programmes resulting in a reduction of $860 million (-18%) including a decrease of $470 million (-11%) at State, $330 million (-100%) at USAID, and $59 million (-46%) at Centres for Disease Control and Prevention (CDC). This means that there will no longer be a global AIDS programme at USAID. In addition, the US contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria would decline by $225 million (-17%).

In addition, funding for the family planning and reproductive health, and vulnerable children programmes under the global health programmes account would be eliminated.

<p>Momina, from Ethiopia, was diagnosed HIV positive when she was already unknowingly pregnant and subsequently unable to access treatment to prevent onward transmission to her child. Four months after he was born she learned his status and took the agonising decision to give him up in the hope that he would receive treatment in the US. Pictured here with her oldest son Rapira. </p>

Momina, from Ethiopia, was diagnosed HIV positive when she was already unknowingly pregnant and subsequently unable to access treatment to prevent onward transmission to her child. Four months after he was born she learned his status and took the agonising decision to give him up in the hope that he would receive treatment in the US. Pictured here with her oldest son Rapira. ©Benjamin Chesterton\duckrabbit\International HIV/AIDS Alliance 

US not paying its fair share

The US remains the largest donor to the HIV response. However, as a proportion of GDP, the US already lags behind other donor countries both in terms of HIV spending and overall aid spending. This is at a time when the global response is geared for a scale-up of treatment and prevention, which is required to control the global epidemic. The UNAIDS 90-90-90 targets are not yet achieved, and funding is essential to achieve this milestone. The US government cuts will have a monumental impact on the lives of people living with and affected by HIV who will not have access to life saving treatment.

The impact is compounded by the reinstatement of the Mexico City Policy earlier in the year. This policy, which is now being extended to all US health funding, is an unprecedented conditionality that is forcing HIV organisations into impossible choices over the populations they can and cannot work with.

Integrated HIV and sexual and reproductive health programmes in danger

In announcing these sweeping cuts, the US State Department argued that the restrictions to family planning programmes as a result of the expanded Mexico City Policy would have no impact on overall health spending. It stated that “departments and agencies will reprogram to other organizations any funding they would have awarded to NGOs that do not agree to the terms [of the expanded Mexico City Policy]”.

However, it is clear that this is only the case if recipients of US HIV spending are prepared to forego integrated HIV and sexual and reproductive health programmes that the world agrees are key to ending AIDS by 2030.

In insisting that HIV organisations sign up to the Mexico City Policy, the US is forcing them literally to make a choice between the populations most affected by HIV. The impact on the sexual and reproductive health care and services provided to women living with and affected by HIV will be catastrophic and remove us further away from ending AIDS as a public health threat by 2030.