We started the 21st century with a few received wisdoms about future progress: Two great expectations for millennials were that free trade would foster global development and diminish inequality, and that we would overcome one of the 20th century’s greatest scourge by ending the AIDS epidemic. Two recent political developments give us a chance to take stock.
On the HIV/AIDS front, the Obama administration just pledged $4.3 billion to the United Nations Global Fund, a primary resource for HIV/AIDS, malaria, and tuberculosis treatment and prevention. It’s a hefty number, but sadly inadequate to comprehensively tackle the epidemic. The 21st century’s first AIDS generation is now entering adulthood, and international funding still lags deeply behind what’s required to fully contain the global HIV/AIDS crisis.
Washington’s pledge continues several years of stagnant funding under PEPFAR, a US-led fund for programs dealing with HIV/AIDS and other infectious diseases. Other donor nations, meanwhile, have significantly ramped up their contributions compared to previous funding levels. The advocacy group Health GAP argues that the pledge is shaped by political calculations, not public-health priorities, as it “falls significantly short of what is needed from the United States to close the widening funding gap for the global AIDS response and capitulates to an irresponsibly low replenishment goal.” The group projects that the new US pledge is the equivalent of an increase of “roughly $80 million per year at a time when $7 billion per year in additional funding is what UNAIDS estimates is needed to put the world on track toward ending the AIDS crisis.”
Hillary Clinton touts her record in championing HIV/AIDS programs through her policy campaigns as first lady and senator, and as Obama’s secretary of state, when she famouly pushed for an “AIDS-free generation.” Yet if she continues the current level of investment in HIV/AIDS programs, she would ensure that the pattern of infection and death will persist well into the next generation. Health GAP projects that “failure to scale up the global HIV response considerably between now and 2020 will result in 17.6 million more new infections and 10.8 million more deaths—increasing the long-term need for HIV treatment and future costs to health systems.”