President George W. Bush deserves much credit for PEPFAR. Republicans (and others) are tarnishing this legacy with punishing cuts to HIV/AIDS services around the world.

I put up a piece this morning under the perhaps-surprising title of George W. Bush brings his awesomeness on AIDS Day. I’m, um, not a huge George W. Bush fan. But PEPFAR was a genuinely great thing. Of course there’s a Nixon-to-China aspect of a Republican president taking leadership in the fight against AIDS. Many others deserve credit. The bottom line is that Bush cared about it and was able to get this done. He’s also doing a great service advocating for sustained global health aid when so many Congressional Republicans (and, shamefully, some Democrats too) have supported and enacted punishing cuts to programs that save literally millions of lives around the globe.

As New York Times reported: “America’s budget crisis at home is forcing the first significant cuts in overseas aid in nearly two decades.” House Republicans propose deep cuts in the State Department and in foreign aid. Many of these cuts fall on evidence-based health and development assistance. As the Washington Post’s Michael Gerson described these cuts earlier this year: “If the goal of House Republicans is to squander the Republican legacy on global health, they are succeeding.” The same thing is happening in other wealthy democracies facing hard economic times.

My TIE post left one thing out: the immediate consequences of donor cuts to HIV programs. Alanna Shaikh at UN Dispatches provides a powerful column on this:

In the face of [great scientific and clinical opportunities], the global community responded in one voice, “Forget it. We don’t care.” Things are hard all around, you know, and foreigners with HIV don’t vote in domestic elections. The Global Fund to Fight AIDS, TB, and Malaria just canceled its next round of grants. The WHO is laying off staff. Bilateral donors are cutting aid to global health. Instead of breaking the cycle of HIV transmission, developing nations will be lucky if they can protect the people they already have on treatment.

That may sound dramatic, but look at the numbers. The Global Fund asked donors for $20 billion. It received $11.5.  Everyone from Germany to the USA reneged on their pledges of support.

What a predictable, infuriating, and short-sighted development. Shaikh notes that we’ll be apologizing to our children for this. The people to whom apology is really owed won’t hear it. Many will soon be dead.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect,, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

3 thoughts on “AIDS Day”

  1. Presidents Bush, Obama, and Clinton spoke at the Aids Walk this AM. Also Senator Rubio. Here was the rare case of bipartisan effort that has really paid off in millions of lives saved. Clinton noted that favorability of US in Africa, including Muslim countries, very high because of this work. Clinton quoted Gates to effect this was pretty cheap form of national security. Particularly recommend Q&A with Clinton towards end.

  2. Interestingly this was sort of a win win for Bush in that it allowed him to find a way to fund some right wing Christian groups to do this work which has unfortunately brought some bad abstinence-only and anti syringe exchange habits over from the US. No matter. Just getting drugs and additional help to people has been worth it. HIV has been a lot more bipartisan than one might think. Ted Kennedy and Orrin Hatch created Ryan White. IT’s an odd situation because the disease is increasing both abroad and in the US but we act as if we can just cap the investment. the fact is if we do not work to prevent infections and get people on treatment now (and there is a ton of new research about how to do that – including the use of anti-retrovirals in new ways) we are just simply going to pay for treatment and hospitalizations at a higher cost later. It’s penny-wise and pound-foolish. So thanks for writing about this.

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