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USA/Africa: Health Budget Falls Short

AfricaFocus Bulletin
Feb 5, 2008 (080205)
(Reposted from sources cited below)

Editor's Note

United States President George W. Bush has asked Congress to vote an U.S. $30 billion for the President's Emergency Plan for Aids Relief (Pepfar) over the next five years. .. But critics say this is only maintaining the current funding levels when large increases are still needed. Physicians for Human Rights, for example, has called for U.S. $59 billion to fund the fight against Aids, tuberculosis, malaria and other global health programs. And Aids-Free World co-director Stephen Lewis has pointed out that the war in Iraq is taking far more: up to $108 billion a year.

This AfricaFocus Bulletin contains two updates on budget proposals by President Bush and by Congress on global health, and a call for organizational signatures on a letter to members of Congress to support a draft bill proposing to increase the president's proposal from $30 billion to $50 billion. Organizations, both in the United States and elsewhere, are being asked to sign on by the end of the day on February 6, in time for the congressional committee vote expected on February 7. See below for the text of the letter and the e-mail address to send endorsements.

Another AfricaFocus Bulletin sent out today contains an update on a new study showing that anti-malaria interventions, if applied on a national scale, can have dramatic effects in reducing hospitalization and deaths from malaria in children. See

For previous AfricaFocus Bulletins on health issues, visit


New on
5 full-length transcripts of interviews for book:

Mary Jane Patterson -
Ben Magubane -
Robert Van Lierop -
Geri Augusto -
Dumisani Kumalo -

++++++++++++++++++++++end editor's note+++++++++++++++++++++++

Bush Releases FY 2009 Budget With Funding for Global, Domestic HIV/AIDS Programs

February 5, 2008

President Bush on Monday released his $3.1 trillion fiscal year 2009 budget proposal, which allocates funding for global and domestic HIV/AIDS programs, the AP/ reports (Taylor, AP/, 2/5). Under Bush's budget proposal, $4.8 billion would be allocated for the Global HIV/AIDS Initiative, which forms the bulk of funding for the President's Emergency Plan for AIDS Relief. Bush's total request for PEPFAR funding is $6 billion in FY 2009. In addition, the budget would allocate $1.6 billion for child survival and health programs. The budget proposal would allocate $200 million for the Global Fund To Fight AIDS, Tuberculosis and Malaria within the Global HIV/AIDS Initiative account. The Global Fund also would receive $300 million within the National Institute of Allergy and Infectious Diseases account. The budget proposal would provide $300 million for the President's Malaria Initiative and ongoing malaria programs worldwide. Bush also requested $2.2 billion for the Millennium Challenge Corporation, a program meant to encourage economic and political reforms in developing countries (President's FY 2009 budget, 2/4).

Bush Proposes More Funds for Aids Fight

29 January 2008

By Brian Kennedy and Katy Gabel, Washington, DC

[reposted with permission]

United States President George W. Bush has asked Congress to vote an extra U.S. $30 billion for the President's Emergency Plan for Aids Relief (Pepfar) over the next five years.

In his final State of the Union address, delivered to Congress Monday night, Bush said: "We can bring healing and hope to many more. So I ask you to maintain the principles that have changed behavior and made this program a success ... I call on you to double our initial commitment to fighting HIV/AIDS by approving an additional $30 billion ..."

According to the White House, 1.4 million people have benefited from the Pepfar program. In an interview with USA Today last week, President Bush called Pepfar "a strategy that is working" and one that "has made a difference in over a million people's lives in a relatively quick period of time."

Bush says millions more lives can be saved with Pepfar funding. But David Bryden of the Global Aids Alliance accused him of obscuring the issues around HIV/Aids funding through the ambiguous use of language, stating that HIV/Aids funding is actually "flat-funding."

"The President has proposed 'doubling' spending to $30 billion, but the reality is that his proposal would not double current spending at all," said Bryden.

According to Bryden, the U.S. is spending U.S. $6 billion on HIV/Aids in 2008. Over five years, the total would be U.S. $30 billion, equaling the amount of spending Bush calls for.

Physicians for Human Rights echoed Bryden's desire for more funding, calling in a statement for U.S. $59 billion to fund the fight against Aids, tuberculosis, malaria and other global health programs. The advocacy group also called for more programs targeted at women.

"He should fund it like his life depended on it - millions of other lives do," said John Bradshaw, the group's director of public policy.

In a recent speech at Harvard Medical School, Aids-Free World co-director Stephen Lewis pointed out the difference in spending between HIV/Aids and Iraq.

"The [United States] administration spends, conservatively, up to $108 billion a year on the war in Iraq, and perhaps $5 billion in an entire year on HIV/AIDS," said Lewis. "Those priorities are so skewed as to be obscene."

Joining Bush's wife, Laura, in Congress for the State of the Union was Tanzanian Tatu Msangi and her daughter, Faith Mang'ehe. Msangi is HIV-positive, but her daughter does not have HIV because of a Prevention of Mother-to-Child Transmission program supported by Pepfar, according to a White House statement.

Addressing the fight against malaria, Bush told Congress: "With your help, we are working to cut by half the number of malaria-related deaths in 15 African nations." Earlier this week he called for an expansion of the Presidential Malaria Initiative.

Bryden, however, said that without additional money, "flat-funding may even affect malaria programs."

Bush also called for full funding for the Millennium Challenge Account, an aid program introduced by the Bush administration in 2002 to distribute foreign development assistance by following a corporate model. "This program strengthens democracy, transparency, and the rule of law in developing nations," the president said.

He did not limit his focus on Africa to health-related funding. "America is opposing genocide in Sudan," he said. He also called for "supporting freedom" in Zimbabwe, where elections are scheduled for March.

Karen Hirschfeld, Sudan campaign director for Physicians for Human Rights, called his statement on the country "empty rhetoric" that should be replaced with real action.

Last week, the White House announced that Bush will travel to five African countries from February 15 to February 21.

Organizational Sign-On Letter

[More than 50 organizations have already signed. Please send organizational endorsements by 5 p.m. U.S. east coast time to]

For more information contact:
Paul Davis , Health GAP (Global Access Project) +1 215.833.4102 (mobile)
Skype/AIM: pdavisx

February 2, 2008

Dear friends in the fight against global AIDS,

February 7th is a momentous event in the history of the fight against global AIDS. On that day, the U.S. House of Representatives' Committee on Foreign Affairs will introduce and vote on the second five years of U.S. Efforts to fight global AIDS. Right now, the draft bill contains $50 billion - a TWENTY BILLION INCREASE over what the outgoing President has requested. It sets some historic high water marks for commitment to support AIDS treatment and prevention, but also goes a long way to move from emergency to sustainability, with important new sections on health workforce, health systems, TB and malaria, coordination and integration, and very substantial new new support for women and girls and evidence-based prevention.

The excitement around this bill is also allowing several other very important and overdue initiatives that have not passed on their own to be attached to this bill, including much of the Microbicides Development Act and a repeal of the shameful U.S. travel ban against people with HIV.

[NOTE: endorsements must be received by 5 p.m. U.S. east coast time. Please send to]


Feb 7, 2008

Dear Members of the House Committee on Foreign Affairs,

We write as members of the worldwide movement of organizations concerned about AIDS and global health. We urge you to support passage of Chair's text of the U.S. Global HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 - a renewed and improved version of the President's Emergency Plan for AIDS Relief (PEPFAR).

This bill continues and builds on the progress made by current U.S. Global health initiatives, and affirms U.S. commitments made to achieve universal access to AIDS treatment, prevention and care, as well as meeting targets pledged against tuberculosis and malaria.

In addition to providing assistance for prevention of new HIV infections and treating and caring for people living with HIV/AIDS, the bill also aims to transition U.S. global AIDS programs from an emergency phase to a sustainable one. The bill increases flexibility in budget programming, Allows a more comprehensive approach to prevention including new activities to address the vulnerabilities of women and children, strengthening health systems by providing technical and financial support to countries to develop and implement health workforce plans and support for training and retaining necessary new health workers, supporting scientific research for new vaccines, microbicides and prevention technologies and strengthens coordination efforts across U.S. agencies on HIV/AIDS, TB, and malaria programs.

The bill establishes in legislation a U.S. malaria program, continuing and building upon the President's Malaria Initiative that has already contributed greatly to improvements in the fight to eradicate malaria. It also includes assistance for activities aiming to prevent and stop the spread of tuberculosis - a disease that knows no borders as witnessed by the MDR-TB case in the U.S. last spring.

There is a continued need to scale up access to treatment and to get important new first and second line regimens to more of the people in clinical need. And to succeed sustainably, impoverished countries must be substantially supported significant increases the number of health workers trained -- and supported so they can do their jobs in their countries of origin. The bill also affirms the U.S. commitment to support the multilateral Global Fund to fight AIDS, Tuberculosis and Malaria.

To achieve the goals in prevention, treatment, care and to ensure a holistic approach to HIV/AIDS, TB, and malaria and the health workforce necessary to keep U.S. commitments, a minimum of $50-to-$59 billion is needed over five years.

To demonstrate continued U.S. commitment to partners in the developing world and to show that Americans intend to sustain work against AIDS worldwide through increased investments and sound policies on global health, we urge that you support passage of this legislation with at least $50-$59 billion over five years, and all of the policies and improved program targets in the current draft bill.

[NOTE: some of these program targets may be added to the final text of this letter. See summary below.]

Thank you for your consideration.


Summary of Key Provisions in The U.S. Global HIV/AIDS, TB, Malaria Reauthorization Act of 2008

Known as "The Global AIDS bill"


  1. Establishes a comprehensive, integrated five-year global strategy to fight HIV/AIDS, Tuberculosis, and Malaria
  2. Supports treatment for three million people with HIV, prevents 12 million new infections, care for 12 mn PWHIV
  3. NEW pieces on TB, malaria, health workforce and health systems, microbicide development, AIDS-related nutrition, protections for women and youth

Policy Planning and Coordination:

--develops a five year comprehensive strategy to combat HIV/AIDS that includes:

  • A comprehensive, evidence-based approach to prevention
  • Specific linkages to food and nutrition, other basic health and development services
  • Include prevention and treatment services for injection drug users
  • Medical, social, and legal services for victims of violence

Research, including incentives for HIV vaccine development and new protocols

  • Greatly improves US interagency coordination across a spectrum of USG agencies for reviewing progress in host countries towards HIV/AIDS prevention, care and treatment objectives; identifying countries; reviewing policies that may be obstacles to reaching prevention, treatment and care goals; and coordinating with other U.S. foreign assistance particularly in the areas of health and development
  • Improves coordination with other donors and development partners at the country level, improves transparency and accountability

Global Fund:

  • Continues U.S. commitment to the Global Fund, including a contribution of $2 billion for 09 and '10, such sums as necessary thereafter.
  • Retains 33% contribution


  • Continues the ABC model aimed at prevention with strong emphasis on delay of sexual debut, abstinence, partner reduction, and life-skills programs, particularly for women and girls.
  • Eliminates the abstinence earmark and enhances abstinence as a part of the ABC strategy. Conscience clause is retained, so that no PEPFAR contractor is required to deliver condoms.
  • Eliminates the prostitution pledge and strengthens language on countering HIV/AIDS for victims of trafficking.
  • Also includes counseling and testing including counseling to prevention sexual transmission of HIV; education and outreach including MSM


  • Calls on addressing specific barriers to treatment services
  • Supporting one-third of the people with HIV/AIDS in clinical need and three million people
  • Access to psychosocial support systems
  • Calls for purchasing drugs at the lowest price available

Referral Systems/Coordination

  • Calls for integration and coordination within HIV/AIDS prevention, treatment and care and across global health and development programs
  • Includes nutrition as a key component of treatment, including important new Body Mass Index target to ensure people with HIC are eating and able to adhere to medications.

Health Systems/Health Care Workers

  • Supports country-led five year health workforce plans to train and retain new health workers
  • strengthens health systems in host countries including hospitals, clinics, medical equipment, laboratories, supply chain management systems, and capacity building.
  • Provided technical and financial support, with countries and other development partners to achieve WHO-minimum health workforce densities of 2.3 doctors, nurses and midwives per thousand residents.


  • Substantial enhancement of programs to prevent mother-to-child transmission of HIV with new coverage targets to reach 80% of pregnant women in countries most affected by HIV/AIDS


Eliminates the HIV/AIDS travel ban that prohibits people with HIV from entering the United States.

Authorization of Appropriations:

Authorizes a total of $10 billion annually to combat AIDS, TB, malaria, support the GFATM, launch stronger PMTC and AIDS-related nutrition programs, health workforce training and retention measures and health systems strengthening, and support for orphans and vulnerable children under the Act for FY 2009 to 2013.


  • Incorporates H.R. 1567, the Stop Tuberculosis (TB) Now Act of 2007 sponsored by Mr. Engel.
  • Creates linkages and requires patient referrals between HIV/AIDS and TB programs.
  • Creates new strategy to stop TB by enhancing testing and treatment in countries with high TB rates.
  • Creates new strategies for attacking MDR and XDR forms of drug-resistant TB.
  • Provides assistance for the World Health Organization Stop Tuberculosis Partnership to meet WHO goals to cut TB deaths and infections in half by 2016.
  • Authorizes $4 billion in funding for stop TB programs for FY 2009-2013 out of the overall amounts authorized by the Act.


  • Requires the President to develop a comprehensive 5- year strategy to combat malaria globally and strengthen United States leadership against this disease.
  • Creates a new Coordinator of United States Government Activities to Combat Malaria Globally.
  • Authorizes United States contributions to the WHO Roll Back Malaria Partnership to improve capacity of countries with high rates of malaria to address the disease.
  • Supports Center for Disease Control and National Institutes of Health clinical research for new diagnostics, treatments and interventions to prevent, cure and control malaria.
  • Authorizes $5 billion in funding for programs to combat malaria for FY 2009-2013 out of the overall amounts authorized by the Act.


  • Incorporates many parts of the Microbicides Development Act, which better coordinates US research efforts towards microbicide development.


Calls for comprehensive U.S. strategy to address the vulnerabilities of women and girls

AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

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