President's proposed budget falls short in commitment to ending AIDS

  • March 11, 2014

HIV/AIDS activists and physicians are expressing their concern over the 2015 budget proposed by President Barack Obama, which has only modest increases to fund HIV/AIDS research at the NIH and flat funding for the President’s Emergency Plan for AIDS Relief, or PEPFAR.

The proposed budget for PEPFAR is $4.35 billion, the same amount that was allocated in 2014. The budget for the Global Fund to Fight AIDS, TB and Malaria was reduced by $300 million.

“With PEPFAR seeing cuts totaling $500 million since 2011, the continued flat funding that the president’s proposed budget represents amounts to a surrender in a fight that can and must be won,” Joel Gallant, MD, MPH, FIDSA, chair of the HIV Medicine Association (HIVMA), said in an HIVMA statement. “While the budget proposal shows a continued commitment to the Global Fund to Fight AIDS, TB and Malaria, an adequately funded PEPFAR is necessary to support the Fund’s partnerships.”

Joel Gallant, MD 

Joel Gallant

According to Chris Collins, vice president of policy of amfAR, The Foundation for AIDS Research, there is strong bipartisan support for PEPFAR and the Global Fund in Congress and within the president’s administration, including support from Secretary of State John Kerry. Kerry is scheduled to testify before the House Appropriations subcommittee on the State Department budget.

“PEPFAR and the Global Fund have made a lot of progress in treatment and prevention around the world,” Collins said during a media briefing. “We are very concerned about the budget put forth by the administration this year and what it will do to the trajectory of the global response for HIV/AIDS.”

The news came in the midst of the 2014 Conference on Retroviruses and Opportunistic Infections, where HIV physicians and researchers gathered to hear the most recent data on treatment, prevention and epidemiology. According to Rochelle Walensky, MD, PhD, professor of medicine at Harvard Medical School and Massachusetts General Hospital, the most recent evidence indicate that the incidence of HIV is dropping in the highest-prevalence countries, and it is dropping even more in PEPFAR countries.

Among all of the good news at CROI, Walensky said there also is worrisome news, including an antiretroviral therapy coverage rate of only 34% for pediatric patients and a postpartum death rate of 66% among mothers with HIV. More than 75% of the women died without ever starting ART.

“PEPFAR could improve these worrisome data,” Walensky said during the media briefing. “We saw that PEPFAR countries have a lower, all-cause mortality compared to non-PEPFAR countries, and we know that ART in South Africa has already saved 2.8 million years of life.”

She said there is now definitive evidence that ART also prevents transmission. There also are data that suggest ART could save money during the next 5 years because it is more expensive to treat opportunistic infections and other HIV complications than it would be to treat patients for a cost of $100 a year.

“Treatment is a triple winner,” Walensky said. “We are saving lives, preventing transmission and maybe even saving money. As scientists, we are charging forward and are eager to win this battle. Now is not the time to pull back.”