Proposed PEPFAR budget cuts have been helpful, says US global AIDS coordinator

U.S. Global AIDS Coordinator Deborah Birx said yesterday that President Donald Trump’s repeated proposals to cut funding for the President’s Emergency Plan for AIDS Relief (PEPFAR) have been helpful in pushing partner governments to be more effective.

“That has actually helped me in communication with governments to talk about how the expectation of this administration is that our programs become more and more impactful with the dollars we have,” Birx said at a State Department briefing.

She noted that PEPFAR has been “fully funded” during the past three years. That outcome reflects the U.S. Congress’s repeated dismissal of White House budget requests that have proposed cutting the flagship global health initiative’s budget by $800 million — nearly 20%. Even with strong congressional support, PEPFAR’s funding has remained mostly flat since 2009, Birx said, noting that the 2019 congressional appropriation was roughly $6 billion, and roughly $1.4 billion of that went to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Birx said that despite the flat budget, the initiative is delivering stronger results.

“In 2009, I think we had 4 to 5 million people on treatment. We now have 15.7 [million]. That doesn’t happen without developing amazing efficiencies and effectiveness,” she said. “So that message allows me to talk to governments about how we improve our programming to be more cost-effective.”

HIV advocates have condemned the Trump administration’s proposals to slash funding at a critical moment in the fight against the epidemic, when it could either be brought under control or allowed to persist and spread among populations that have proven more difficult to reach with prevention and treatment.

In 2017, the ONE Campaign argued that if Trump’s budget proposal was put into effect, it “would force PEPFAR to implement a strategy that could result in nearly 300,000 deaths and more than 1.75 million new infections each year.”

Birx made her remarks ahead of World AIDS Day on Dec. 1, and as PEPFAR delivers its annual progress report to Congress. In addition to providing antiretroviral treatment for 15.7 million people, Birx announced that PEPFAR has now supported 23 million voluntary male circumcisions, which can lead to a 65% lower incidence of HIV, she said.

Birx also announced new results from PEPFAR’s DREAMS initiative — which stands for “Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe,” and aims to provide an integrated, community-based approach to preventing HIV in adolescent girls and young women.

For the first time since the initiative started three years ago, all 86 districts in 10 countries where DREAMS operates registered a “uniform decline” in HIV diagnosis among adolescent girls and young women, and a majority of districts have shown a greater than 25% decline in just three years, Birx said.

“From the very beginning, PEPFAR was a bipartisan program, and now through three presidents and nine congresses, we’ve had continuous and unrelenting support,” she said.