Less money, more people sick, and the know-how to stop AIDS? Seems we need a course correction. It is my great hope that the President announces Thursday that our nation will not relinquish the fight against HIV at this pivotal time in AIDS history. And that if and when he does not back away from the fight, other nations, and Congress, will back him up.
As I talk with people about the need to fund the global AIDS fight, I repeatedly hear two questions: 1) Why would the United States, in a time of economic strife, continue to pour American tax payer dollars into foreign aid? and 2) Doesn't the administration know we have a huge unchecked HIV epidemic stateside?
This blog, I hope, answers both those questions.
In 2009, as I prepared to visit AIDS clinics in Kenya with the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), dangerous political unrest broke out in Nairobi. Members of the Peace Corps and Americans in the U.S. embassy were advised to leave. My parents asked me not to go to Africa. My house sitter asked awkwardly what she should do with my animals "if anything happened."
I called Pam Barnes, EGPAF's then president and CEO, and asked whether we'd be safe. She thought we'd be OK. We were delivering humanitarian relief to dying Africans, and she said that was understood. So I got on the plane.
I walked tensely through the Nairobi airport. I knew I wasn't imagining the danger when our hosts rushed us out to waiting cars saying someone else would collect our luggage for us.
For the next several weeks, we traveled through East and West Kenya visiting urban and rural AIDS clinics and hospitals. We talked with doctors, nurses, health ministers and hundreds of people living with HIV and other conditions such as tuberculosis and malaria who would be terribly sick or dead if it weren't for the generosity of the American people.
President George W. Bush was in office at the time, and much of the work we saw was funded by the President's Emergency Plan for AIDS Relief (PEPFAR)--the program started by his administration to apply American taxpayer dollars to stop AIDS around the world.
As a journalist (and therefore inherently skeptical), whenever I'd read about the wonders of PEPFAR, I couldn't help but question whether a 19-year-old girl deep in the throes of labor in the African bush would know, or care, that her health and that of her baby had been protected by American foreign aid. But every place we visited, we encountered massive gratitude. I know that gratitude myself. Having been diagnosed with HIV in 1996, my life has also been saved by the United States government's investments in HIV/AIDS care and antiretroviral treatment.
One day, we visited a community center in a very poor, rural area. After lunch (cooked in hub caps) we gathered in a building made of cinder blocks with no windows and no doors and listened to how PEPFAR programs for testing and treatment had saved many. The people asked if we had brought more medicine, because they needed more. What do you say in a moment like that? I said more would come, one day. I prayed I wasn't lying.
After the meeting, a small boy, maybe 5 years old or so, led me to a long table covered with vegetables, handmade baskets and leather goods. They were gifts for us. The boy touched an upside-down basket and gestured for me to lift it. Underneath was a live rabbit. He pointed at it, then, at me. The translator explained he wanted me to have it. In an area where there was little food, and most of the animals were so thin they weren't worth eating, the plump rabbit was a precious offering. I picked up the rabbit and handed it to the boy and told the translator to tell him that though I appreciated his gift, I wanted him to keep it so the rabbit could grow up and have (or make) lots more rabbits so he would have food and grow up himself. I said that being able to come back and see him again would make me happier than taking the rabbit. He seemed crestfallen at first that I refused his gift but then his mind worked through it and a smile slowly opened his face. He nodded.
As we drove away, he ran beside our truck lifting the rabbit up triumphantly above his head. It struck me that someone with so little was willing to give so much. But he saw me as connected to the force that had helped keep his family and his community alive.
Suddenly, I understood that humanitarian relief has the power to do what war and traditional diplomacy often cannot.
I remembered how afraid I'd been walking through the airport. It was a sharp contrast to the feeling of being enveloped in goodwill--goodwill that protected me as I moved unharmed, for weeks, through a nation in turmoil.
Our nation's foreign aid programs like PEPFAR and those supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria (to which the United States is the largest donor; a fund currently in crisis as it was announced last week they could not deliver their next scheduled round of grants) as well as other programs under USAID (the United States Agency for International Development) save not only the lives of people in other countries but also Americans' lives--those traveling, living and doing business in other nations as well as Americans at home and Americans serving in our military.
By offering humanitarian and medical assistance to countries that might otherwise fight over food shortages, plagues or lack of clean water and basic health care--we prevent war.
If wealthy nations stand by the sidelines until developing nations collapse into conflict because people are dying in droves and fighting each other to merely exist, then we travel to those areas in fighter jets and Humvees loaded with weapons--not on commercial airplanes and in vans loaded with lifesaving medications and vaccines.
The machine of war and the deaths it requires as fuel can be partially stopped with humanitarian aid.
To me, it makes a lot more sense to use our hard-earned cash to build the health and stability of nations in trouble around the world than it does to underwrite sending American men and women in the military to those nations only to bring some of them home in body bags or missing body parts.
Before I get labeled a bleeding heart liberal let me say I absolutely support our military involvement where it is the only way to protect people from terrorism, tyranny and torture. I am deeply appreciative of all the military personnel around the world, former and present, who risked, and risk, their lives to keeps others safe.
As the daughter of a former captain in the United States Marine Corps I understand and respect that the world can be an ugly place and there are times we have to get ugly to minimize the fallout.
But if I may dare, I'll conjecture that those who know war first hand are likely to believe that warfare should be our last line of defense.
Where we can, we should keep the peace of the world by spreading good health. However, recent developments in our nation's capital may prevent our future ability to do so.
The 12 members of Congress officially known as the Joint Committee on Deficit Reduction--colloquially known as the "Super Committee"--announced last Monday that they could not agree on how to source $1.2 trillion dollars of deficit reduction from the U.S. federal budget. As a result, our nation's default debt reduction plan kicks in. It won't take effect until January 1, 2013. But its implications are devastating to our ability to implement foreign assistance.
Everyone agrees we need to balance the budget. We need to find a total of $4 trillion dollars in deficit reduction over 10 years to get the United States truly back on its financial feet. The central argument on Capitol Hill has been whether we actualize the debt reduction with or without generating additional revenue. The core tenet of current Republican ideology is to insulate the wealthiest Americans from participation in our fiscal repair. Their choice to do so requires Congress to take an axe to discretionary programs--like foreign aid.
The $64,000 dollar question that has burned up the beltway for months is: Will we get to our goal of $4 trillion deficit reduction with some extra help from those who have the most resources, or will we get there by cutting from programs that are essential to keep people alive? Cue to Occupy Wall Street....
Fury at being denied the basics of life does not only exist in sub-Saharan Africa. Witness those Americans who sat still while police doused their eyes with pepper spray. The instinct to fight for our lives is a universal constant. And people are dangerous when they have nothing to lose.
We should not balance our national budget at the expense of some of our nation's wisest investments--those made in foreign aid to support global health.
The plan right now is to do exactly that.
Current budget proposals for fiscal year 2012 by the House State Foreign Operations Appropriations Subcommittee show a 9 percent cut in global health overall. But since the entire budget for foreign assistance (of which global health is a part) is about 1 percent of our nation's total budget, even significant cuts to this line item barely move the needle on our quest for a $4 trillion debt reduction. On the flip side, the proposed cuts to foreign aid/global health will result in the suffering and deaths of millions of people and the spread of disease and agony into future generations.
Surely, saving the lives of tens of millions of people and the protective goodwill it engenders is worth more than a fraction of 1 percent of the entire United States budget.
Development of a nation, possible only with widespread health, enables societies to be more peaceful, democratic and prosperous. Continuing our foreign aid creates the friendships, benevolence and stability that result in safety for Americans abroad and at home. It averts massive suffering. And by allowing the GDPs of developing nations to grow, it also bolsters the global economy.
Helping impoverished nations develop reduces their ongoing need for outside support. It allows them to one day be able to buy their own medications to keep their own people well. Our support of developing nations turns them into customers--which creates more American jobs. When the appetite for our products and services grows, so does our workforce. And so does our economy.
In a letter to the Super Committee, Congressman Howard Berman (D-CA), Ranking Democrat on the House Foreign Affairs Committee wrote, "In this period of belt-tightening and economic uncertainty, some seem to think that foreign assistance is a luxury we can no longer afford. However, with one out of five American jobs tied to international trade, and our fastest growing markets--accounting for roughly half of U.S. exports--located in developing countries, America can't afford a course of isolation and retreat. Our economic fate is interconnected with the rest of the world, and the collapse of developing economies will unavoidably mean our own decline." Conversely, if we pull nations up off their knees and help them blossom we create future markets that sustain our future growth.
One of the best predictors of the strength of a nation is the advancement of its women. But without health, no one can advance. According to the World Health Organization, HIV/AIDS is the number one cause of disease and death among women ages 15 to 44 worldwide. Nothing kills more women. So, if women and girls are the secret to strong nations, letting them die in huge swaths is bad for the stability of the global economy.
The equation is this simple: Without foreign aid, there is often poor health in developing nations; without health, there can be no development; with no development, there is an endless need for foreign aid. If no foreign aid comes, people get sick, die or get desperate and start wars. When that happens, instead of spending money on foreign aid, we may be required to spend it on defense.
Disproportionately slashing programs that show powerful return on a humanitarian level is not only reflective of the wrong ethical values it is also financially irresponsible. As former Secretary of Defense Robert Gates said, "Development is far cheaper than sending in soldiers."
I am not advocating gutting defense spending to fix the financial woes of our nation. As I said, war is sometimes necessary and it's expensive. Rather, I am asking Congress to consider more equitable cuts across various parts of the budget and positing whether maintaining current levels of humanitarian aid could save American taxpayer dollars and lives lost to war in the future.
If the arguments for maintaining, and even increasing, the amount of money our nation devotes to foreign aid are strong, they are particularly strong for one of the largest areas of U.S. funding in our foreign aid portfolio: namely, the fight against HIV/AIDS.
U.S.-funded scientific research showed this summer that maintaining our investment in HIV/AIDS can allow our nation to achieve one of the greatest humanitarian projects it has ever undertaken: heralding in the end of AIDS.
Two weeks ago, at the National Institutes of Health, Secretary of State Hillary Rodham Clinton gave a fantastic speech--"Creating an AIDS-Free Generation"--highlighting the opportunity for the world to begin to end the global AIDS pandemic.
Secretary Clinton explained how with the right mix of strategically applied prevention and treatment, ours can be the generation to scrub HIV off the planet. She cited the power of combination prevention and highlighted three key interventions--ending mother-to-child transmission of HIV, expanding voluntary medical male circumcision and scaling up treatment for people living with HIV/AIDS--as pillars of a strategy to end AIDS around the world.
The results of a recent breakthrough study known as "HPTN 052" show that administering HIV treatment also ensures that the person who receives it becomes less contagious--specifically, HIV treatment can lower the risk of transmission by 96 percent. Therefore, treatment doubles as prevention. This provides the impetus to secure funds needed to get as many people with HIV into care as possible--we will be keeping them alive and stopping the spread of disease in one fell swoop.
And, treating people with HIV/AIDS is more affordable than ever. As Clinton noted in her speech, the cost of providing HIV treatment per person via PEPFAR fell a whopping 24 percent last year. It now costs about $335 per year to keep someone with HIV alive in the developing world.
The United States shouldn't have to pay for the end of AIDS alone. But one of the best ways to inspire other nations to step up with us is to maintain American leadership on HIV/AIDS. We are a canary in a coalmine of sorts. If America doesn't believe in finishing a fight in which we have already invested billions of American taxpayer dollars just when our investments are starting to pay off exponentially, why would other nations think it's a good idea to get involved?
And, no smart investor pulls the plug when the odds of returns are most promising. Depleting funding for HIV/AIDS at this point in time would have a devastating effect on a fight in which we've spent billions of dollars and gained much ground.
Some Americans may ask, despite the obvious benefits of foreign aid, why our nation should spend money overseas when so many are hurting here. There's no question that true global leadership on health requires attending to the health of Americans too. In terms of HIV, of the approximately 27.3 million people with HIV not on treatment around the world, an estimated 850,000 of them are Americans. Changes to our health care system as prescribed by the National HIV/AIDS Strategy and those that will result from the implementation of the Affordable Patient Care Act (when it kicks in fully in 2014) will eventually help ensure more people with HIV in America get care. We have to figure out how to bridge to 2014 in a way that ensures more Americans with HIV--and other health concerns--get care. While it may seem counterintuitive on the surface, supporting our international AIDS programs gives us the proof of concept and scientific insight we need to lobby for--and deliver--better care at home.
Remember, it was in Africa and other developing nations that we conducted the AIDS research that led to our current scientific knowledge. And the insight we've gained in AIDS research is helping with other diseases too. A major scientific breakthrough in AIDS has led to our ability to fight cancer better. And, AIDS drugs are showing promise in fighting other viruses.
It was in places like Africa that we learned how to treat AIDS in challenging settings. We have fought AIDS in rural villages and urban ghettoes in developing nations where there is violence, low literacy, addiction, domestic abuse, a lack of health care infrastructure, racism, homophobia, a lack of trust of the establishment, poverty, orphans, joblessness, homelessness, lack of education, lack of hope, despair, rage, depression, no clean water, no food and no medical workers. This has prepared us well to fight HIV on our own soil in places like Newark, Baltimore, Detroit, South Central Los Angeles, the Bronx, Mississippi, Alabama, Appalachia--and the District of Columbia.
It appears the Obama administration is committed to finishing the war on HIV. In her recent speech, Secretary Clinton said, "Creating an AIDS-free generation has never been a policy priority for the United States government until today." In the days since her remarks, people around the world in the HIV/AIDS community have been on the edge of their seats waiting to see whether President Obama will personally pledge his ongoing leadership to the global AIDS fight. Specifically, that he will defend the PEPFAR budget, domestic HIV/AIDS funding and the U.S.'s $4 billion commitment to the Global Fund. And, in doing so, enable the world to put more people on treatment--a move that has the beneficial side effect of stopping the spread of HIV around the globe.
Hopefully, he will do just that this Thursday, when the eyes of the world will be watching him.
Unflinching presidential and bi-partisan congressional support of global health, particularly the winnable battle of HIV/AIDS, especially in times of economic straits, will stand as a platinum example of one of America's greatest core qualities: the fact that we don't turn our back on the horrors of the world. We help fix them.
We must consider that the benevolence created by our humanitarian largesse could be replaced with equal fury if the world sees America's leaders decide not to spend a tiny portion of our great wealth to save tens of millions of lives.
Slashing foreign aid now is not merely a budget cut. It borders on genocide.
I hope those at the helm of this great nation will not decide to condemn tens of millions of mothers, brothers, wives, husbands, sons, daughters, cousins, babies, friends and grandparents to unnecessary and premature death merely because those people cannot influence U.S. policy makers with campaign contributions and votes.
Make the cuts and find the deficit reductions to our federal budget we must, but let's make and find them where they will do the most good for the most people--both inside our borders and around the world. We can easily preserve our military might without having to remove the powerful tool of humanitarian aid from our arsenal.
Be sure of one thing: The decisions we make when cutting our federal budget move like a boomerang. Everything we choose today comes straight back at us tomorrow. And it comes back with either a thank you--or a vengeance.
I am afraid to live in a world that knows we had the power to help but decided not to.
I want to go back to Africa one day and see that small boy and his rabbits. And when I do, I hope I will be able to feel the same pride I did a couple years ago when I could legitimately say I was proud to be an American. And I hope to still feel as safe in the world because the world still sees Americans as lifesavers.
As we count down to World AIDS Day, I remain optimistic that the man I elected with great hope in my heart will step up and demonstrate one of the best of all American virtues: our unmatched humanitarian largesse. As Secretary Clinton has said, "The worst plague of our lifetime brought out the best in humanity."
Of all the things we could buy with our money, a generation free of HIV and the more peaceful world it will create seems a wise investment, does it not?
Because even as we lick our own wounds, our continued support of global health, particularly for people with HIV/AIDS, allows us to make love--instead of war.