Budget Cuts & Lost Trust

In spite of the endless analysis and hovering media attention during the new Congress's "100 hours," one of the first major budget decisions has somehow gone largely unnoticed: the Democrats decided to nix the Republican's 2007 budget request and continue funding programs at FY06 levels. As Desmond Tutu wrote in Monday's Washington Post, the effects of this decision could be tragic for many Africans infected or affected by HIV/AIDS:

Staying at 2006 funding levels would result in a loss of up to $700 million for the 15 PEPFAR focus countries. As a result, 280,000 fewer people will be put on AIDS treatment. That is 280,000 lives needlessly lost.

At a recent event at the Global Health Council, the US Global AIDS Coordinator, Ambassador Mark Dybul, sounded a similar warning about lost AIDS funding, noting that the greatest cost of funding cuts might not be the lives lost, but rather the broken trust between US government officials and the recipient country governments. From the time the President's Emergency Plan for AIDS Relief was first announced, it was modeled on the concept that AIDS funding would increase significantly for five subsequent years. Governments, NGOs and contractors working on AIDS within the focus countries were asked to plan accordingly and to make time-consuming preparations to ensure that the money arriving could be used effectively. But now four years into PEPFAR funding, governments and other implementers are suddenly being told that there may be no funding increases after all. Dealing with the fallout from this sudden change of course could be extremely difficult; as Ambassador Dybul says:

We have heard from governments that if we don't meet our '07 commitment, they don't see any reason to believe we'll ever have a commitment for them. They certainly aren't going to trust anything we say about 2009 when the Emergency Plan ends. The chilling effect long term for scale up is almost beyond comprehension in our view because of that delay.