In Washington, D.C. right now there is no getting away from the fiscal cliff.
So in the lead up to World AIDS Day, usually a pretty good day for making the general public aware of the global AIDS crisis, I feared that it would be all lost -- HIV/AIDS would be relegated to a sideshow amid the squabbling over tax cuts and revenue brackets.
I wasn't prepared to get naked and pop into a Congressional office with my naked friends as some brave domestic AIDS activists did a couple of days ago, so I had almost accepted that it might be a wash.
But yesterday Hilary Clinton released the U.S. government Blueprint for an AIDS-Free Generation, detailing the U.S. role in ushering in AIDS-free generation and ending the global HIV/AIDS pandemic.
As a tuberculosis (TB) advocate, I had grown used to seeing TB relegated to the footnotes of AIDS reports even though TB kills nearly one in four people living with HIV.
But there it was, front and center: tuberculosis.
Broadly, the Blueprint sets out to target HIV-associated tuberculosis to reduce deaths from the two diseases.
In order to achieve that, the plan's suggestions include:
- All people living with HIV who are diagnosed with TB should immediately be put onto antiretroviral treatment (ART);
- We must expand access to new technologies likes GeneXpert to improve the early diagnosis of TB in people living with HIV, and;
- Pregnant women and children should be screened for TB.
This is the most clear and strategic plan from the U.S. government for combatting the two diseases together that I have ever seen.
And it's about time. Despite Congressional champions, including those who formed the U.S. House Tuberculosis Elimination Caucus, and long-time champions including Ohio Senator Sherrod Brown, together TB and HIV have killed millions of people over the last decades.
It's been proven repeatedly that if we increase investments in interventions that tackle HIV and TB at the same time -- such as using TB clinics to provide ART to people living with HIV -- we can save millions of lives.
The Blueprint is a solid, thoughtful and compassionate piece of policy that demonstrates a deep understanding of what it is really going to take to end these two diseases.
But that's where it can all get tricky.
While the plans laid out in the Blueprint are both concrete and visionary, this is -- or so they keep reminding us -- a time of 'fiscal cliffs' and an 'age of austerity.'
We are told all governments need to cutback spending and get smart with tax dollars, the inference being that spending on global health and other foreign aid commitments is frivolous.
It's easy to call out foreign aid as a scapegoat, but this is because most people grossly overestimate how much, at least in the U.S., we actually spend.
On average, Americans think the U.S. government spends a whopping 21 percent on foreign aid. Attention fellow Americans: The number is actually closer to 1 percent.
Europe is in a similar boat. The European Union holds one of the biggest development budgets in the world, but its leaders seem poised to slash foreign aid budget lines.
A true leadership test on commitment to global health will come in the fall when leaders of donor countries meet to discuss a replenishment of funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Can leaders battle through domestic financial hardships to follow through with the plans that have been laid?
According to Desmond Tutu, "If there was ever a clear justification for finding more money to fight AIDS, the Blueprint is it."
In 2013, activists and advocates for TB-HIV will call for leadership and funding to support the most important multi-country mechanism we have to end these diseases. This will be a a critical and historic moment in the history of global health.
We must fully fund the Global Fund.
Kolleen Bouchane is the director of ACTION, a global partnership of advocacy organizations working to influence policy and mobilize resources to fight diseases of poverty and improve equitable access to health services. ACTION's current focus issues are tuberculosis (TB) - the leading killer of people with HIV/AIDS -- and increasing equitable access to childhood vaccines.
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