About the Author: Ambassador Eric Goosby serves as U.S. Global AIDS Coordinator.
Over the last two weeks, I've had the opportunity to visit programs supported by the United States through PEPFAR in three African countries -- Tanzania, Mali, and Nigeria.
I have visited multiple PEPFAR-supported economic empowerment groups and groups of people living with HIV. The common denominator was this: from the bottom of their hearts, people thanked the American people for our support and noted that if we stopped, they do not know what they would do.
They remember how different things were just a few years ago, when there was little hope and hospitals were overcrowded with people dying from AIDS. And they get that the U.S. has been at the forefront of this transformation.
In public discussion of PEPFAR, it is important to accurately reflect the impact the U.S. is making -- and has committed to continue to make. If people are given a misleading impression that our investments are not saving lives, they may be tempted to give up on this effort. That would be a tragedy.
The United States is committed to saving lives in the developing world. The Obama Administration believes that it is in keeping with America's values and in service of the security of our nation and our common security to take the lead in helping to save lives and relieve suffering, especially among the world's poorest people.
That is why President Obama has undertaken a comprehensive Global Health Initiative (GHI) -- investing $63 billion over six years to help partner countries improve the health of their people through an integrated approach.
There is no doubt that there is ongoing, unmet need for HIV prevention, treatment and care. That's why, as part of the GHI, we are increasing funding for PEPFAR, and doing so in a very tight fiscal environment. The President requested increases for PEPFAR in both his FY 2010 and FY 2011 budgets. In fact, the FY 2011 request is the largest request to date in a President's Budget, and the program is slated to increase in the years ahead.
But the metric for success is not dollars spent, but actual lives saved. Some critics have mistakenly alleged reduced or flat-lined funding under PEPFAR, translating that into a reduction in the number of people getting antiretroviral therapy (ART). Yet the number of people PEPFAR directly supports on ART has continued to increase dramatically each year -- in FY 2009 alone, from approximately 1.6 million to nearly 2.5 million. Without ART, very few of those people would be alive -- that's why lives saved, rather than dollars spent, is most meaningful.
What's more, PEPFAR will continue to increase the numbers treated in coming years toward our ambitious goal under the GHI of treatment for more than 4 million. That's a commitment we've made publicly.
Critics have alleged a negative impact in South Africa due to "flat-lined" PEPFAR budgets in the country. But in 2009, PEPFAR announced plans to add $120 million to our already very large budget there to support the South African Government's effort to rapidly scale up treatment. That is not a flat-line.
Treatment is indispensable, but we need to do more than simply expand access to treatment to change the course of the HIV epidemic. Ending this epidemic also requires reducing the number of those who become HIV-positive. This means access to an array of evidence-based HIV prevention interventions, as well as HIV counseling and testing, and it requires improving the health systems at every level.
The comprehensive approach we are pursuing through the GHI, which includes a focus on maternal/child health, on strengthening health systems, going after neglected tropical diseases, and -- yes -- providing more funding for ART and other HIV programs, will have a significant and swift impact on the longevity and quality of life of millions of people now suffering from preventable and treatable diseases. Also important is maintaining the gains we do make which can be done by strengthening health systems, improving nutrition, and other aspects of this approach. Lives saved, diseases prevented and even eradicated, health systems and nations strengthened -- these are the goals by which global health efforts should be measured. And we are confident that by those measures, our efforts under the GHI will prove to be a success.
A lasting solution to HIV and other global health needs must also involve participation from partner governments and other donors around meeting this shared global responsibility. A key focus of the GHI is to strengthen and leverage key multilateral organizations, global health partnerships, and private sector efforts. In addition to our bilateral programs, the U.S. is also by far the largest donor to the Global Fund to Fight AIDS, Tuberculosis and Malaria, a key multilateral vehicle for countries and the private sector to contribute to the fight.
As we focus on the challenges of the future, let's not lose sight of the remarkable things that have already been accomplished. I wish that everyone reading this had the opportunity I have had to visit the people we work with in the field, to be inspired by them. If the global community can come together to support those people, in a spirit of partnership, I know we can meet the challenges ahead.