By DR. GRANT COLFAX & DR. ERIC GOOSBY
As the two people who worked as physicians in the early years of the HIV/AIDS epidemic before the miracle of antiretroviral drug (ARV) therapy, and who now have the honor of leading the domestic and global HIV/AIDS programs for the Obama administration, we look back in awe of the American leadership that has transformed the epidemic in the 22 years since the International AIDS Conference was last held on U.S. soil. As we remember the lives lost to this disease and commit to the vision of an AIDS-free generation, it’s worth reflecting on how U.S. leadership and U.S. investments to combat HIV/AIDS domestically and internationally are saving lives and turning the tide against the disease.
Here at home, we have more than tripled the life expectancy of people living with HIV/AIDS since 1993. More than half a million persons living with HIV receive care and treatment through the Ryan White program, established in 1990 and maintained with consistent bipartisan congressional support through four administrations. Successful prevention efforts have averted more than 350,000 new infections and mother-to-child transmission of HIV has dropped by more than 90 percent since the early 1990s. HIV prevention has also generated substantial economic benefits. A recent study estimated that HIV prevention efforts in the United States have saved $129.9 billion in medical costs.
In 2010, President Obama released the first-ever National HIV/AIDS Strategy, and he has made implementing the strategy a top priority by requesting increased funding for HIV treatment and care services every fiscal year. In Fiscal Year (FY) 2013, the president’s domestic budget for HIV/AIDS is $22.25 billion, including requesting a $40 million increase for the Centers for Disease Control and Prevention (CDC) HIV prevention efforts, and an additional $74 million to increase treatment and care services for our nation’s veterans living with HIV. The president has also increased federal investments for AIDS Drug Assistance Programs (ADAPs) to expand access to life-saving medications and assist states with ADAP waiting lists. A shared federal-state program, federal funding for ADAPs has increased every year of the Obama administration, rising from $815 million in FY 2009 to $933 million in FY 2012. In FY 2013, the president proposed a total of $1 billion for ADAPs, a $67 million increase above FY 2012. These steps have concrete results — ADAP waitlists have declined by 80 percent since September 2011, dropping from more than 9,000 to approximately 2,000 today, and the federal budget provides sufficient resources to end the waitlists once and for all, if states also step up and do their part.
In addition, people living with HIV have much to gain from the Affordable Care Act. People with HIV are more likely to be uninsured, are more likely to face barriers in accessing medical care, and often experience higher rates of stigma and discrimination than other groups. The Affordable Care Act seeks to expand Medicaid for the lowest income people; it strengthens and improves Medicare, and makes private insurance work better for all Americans, including people with HIV. The Act also prohibits discrimination on the basis of HIV status, bans lifetime limits on insurance coverage and is phasing out annual limits in coverage.
Globally and building on the strong foundation laid by President George W. Bush, the Obama administration has made unprecedented progress in the fight against AIDS. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has expanded its prevention, care and treatment programming, and now has significant investments in more than 80 countries in several regions worldwide. Since FY 2008, PEPFAR has increased the number of people supported on treatment by more than 2.1 million and the number of individuals receiving HIV testing and counseling by almost 19.9 million, supporting nearly four million people on treatment HIV testing and counseling for more than 40 million people in 2011 alone. And on World AIDS Day 2011, President Obama announced a new treatment goal of reaching six million people by the end of 2013.
Since taking office, President Obama has requested more than $26 billion in funding for global HIV/AIDS, including both bilateral U.S. government PEPFAR programs and our contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria. In his FY 2013 Budget, the president fulfilled his historic commitment to request $4 billion over three years for the Global Fund. We are grateful for the bipartisan support that PEPFAR has received from Congress since its inception and the continued bipartisan support for the Global Fund.
In FY 2013, we made the decision to re-allocate resources from within PEPFAR and take an exceptional step at a unique moment to strengthen the Global Fund. Because of the interdependence of the two programs, strengthening the Global Fund now will also help ensure the success of PEPFAR; equally as important, U.S. contributions to multilateral institutions like the Global Fund allow us to leverage increased contributions from other countries. In recent months, new and existing donors, including Saudi Arabia, Japan, Germany and the Gates Foundation, have stepped up their contributions. We know that other donors are also planning to do the same.
The fact of the matter is that our achievements are continuing to grow rapidly. This is due to greater efficiencies borne of driving our programming with evidence of impact, the growing commitment of governments and citizens in the developing world, the reduced costs of treatment, and the growing impact of prevention. With our current budget request PEPFAR will meet the President’s World AIDS Day goals for treatment, care and prevention, including the dramatic increase in people supported on treatment from 4 to 6 million. Along with complementary efforts to strengthen the Global Fund, this will accelerate progress toward the goal of an AIDS-free generation.
While tough budget decisions come with the job, President Obama has committed us to achieving more in the fight to create an AIDS-free generation in the U.S. and across the globe, and we’re succeeding. That continues the legacy of American leadership on HIV/AIDS that should make us all proud.
Dr. Grant Colfax is director of the Office of National AIDS Policy and Dr. Eric Goosby is the nation’s Global AIDS Coordinator.