World AIDS Day is an appropriate time to look at the allocation of funds to HIV/AIDS prevention, services, and treatment. And the global drive for austerity in developed economies, combined with sharp arguments about U.S. government spending, points to potential difficulties.
According to the Kaiser Family Foundation, donor funding for poor and middle income nations (PDF) amounted to $7.6 billion in 2011, which is roughly the same level as it was in 2008. That follows a six-fold increase from 2002 to 2008. In 2011, more than half of that money came from the United States with the United Kingdom and France rounding out the top three. According to the U.N. (PDF), 60 percent of all people living with HIV are in sub-Saharan Africa and international donations account for some two-thirds of all funding for HIV/AIDS in Africa.
The United States’ efforts to combat HIV/AIDS are spread across treatment, prevention and services for those affected both at home and abroad. U.S. global anti-AIDS efforts were vastly expanded in the Bush administration under U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, which provided for a Ambassadorial-level official in charge of global AIDS coordination and now works in 58 countries. All told, in the 2012 fiscal year, the U.S. government spent $27.7 billion on HIV/AIDS, with more than $21 billion spent domestically. The president’s fiscal year 2013 budget request envisions a 2.8 percent increase in the total AIDS budget, up to $28.4 billion.
However, even current funding, let alone planned funding growth, is endangered by the sequester, the mandated reduction in government spending that could phase in starting January 1, 2013. This is the non-taxation portion of the so-called “Fiscal Cliff” and totals some $109 billion in 2013 (PDF). The sequester implies an 8.2 percent across the board cut for discretionary spending programs that weren’t specifically carved out. The cuts would only go into full effect if the sequester were enacted for the entire year and no effort was made to reverse them. And there is some possibility that individual agencies would have discretion to distribute the cuts among programs. But Chris Collins of AMFAR explains that it’s essentially impossible to usefully project how this ad-hoc budget and time-shifting would work.
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