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Will The Next President Be The One Who Commits The Resources Needed To End AIDS?

Starting in May, a coalition of advocates have been engaging with the Clinton, Sanders, and Trump campaigns to get agreement on a consensus statement with a range of domestic and global asks.
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For over a year, AIDS advocates across the country have been publicly challenging presidential candidates to make concrete commitments to the policies and funding needed to curb the AIDS pandemic. For an entire year, student AIDS activists questioned candidates publicly at campaign events throughout the country, prompting verbal agreements from both democratic and republican primary challengers. Starting in May, a coalition of advocates have been engaging with the Clinton, Sanders, and Trump campaigns to get agreement on a consensus statement with a range of domestic and global asks.

A key ask of advocates around the world is a commitment to increase the budget of U.S. global AIDS programs by at least $2 billion per year by 2020.

Out of the 37 million people living with HIV worldwide, 20 million of them have no access to HIV treatment. Every year, 2 million people are still infected, and 1.2 million people die needlessly. With highly effective antiretroviral therapy, taken either as treatment or prevention, we have the means to end the pandemic by drastically scaling up access to treatment. Doing so will reduce new infections, while also eliminating preventable deaths. If we don't double the numbers of people in treatment in the next 4 years, the AIDS epidemic will continue to outrun our response. Without scale-up, we will increase the long-term need for HIV treatment, increase future costs to health systems, and most importantly, countless people will die.

An extra $2 billion per year will allow us to double the numbers of people directly supported by the US in treatment. Now that the nominations are over, let's take a look at where the remaining major party candidates stand.

Republicans have previously been champions of the global AIDS response. President George W. Bush started PEPFAR, the U.S.-funded bilateral global AIDS program, and global AIDS efforts have long had bipartisan support. However, Donald Trump has still not presented a plan for addressing the AIDS epidemic, or answered the two policy surveys sent from leading HIV/AIDS organizations, nor has his team responded to meeting requests from the ad-hoc coalition. In any case, after his bizarrely boastful statements after the Pulse nightclub shootings in Orlando and his repeated demonization of American Muslims, no one in particular was looking forward to sitting in a room with him anyway.

Hillary Clinton has updated her HIV policy statement twice since March, and also responded to a survey from AIDS advocacy organizations in the United States. You can read Clinton's full answers here. When asked, "will you commit to ensuring the necessary funding to double the number of people directly supported by the U.S. on life-saving HIV medicine by 2020?", Secretary Clinton talked at length on her record, but failed to actually make a campaign promise.

Clinton coined the term "AIDS-Free Generation" when she was Secretary of State and she often talks about her positive record on PEPFAR. On the campaign trail in the Fall, she committed verbally to helping get 30 million people in HIV treatment by 2020, but did not make a commitment in writing.

Since May, advocates from across the country have met with her and her policy advisors on two separate occasions to explain the critical policy changes and funding increases necessary to scale up the AIDS response here in the US, and across the world, as described in a community consensus statement already provided.

After the Democratic convention, we finally received an updated policy briefing. She promised to, "Expand critical programs needed to reach and sustain an AIDS-free Generation, including to, "dramatically increase the number of people on HIV treatment worldwide, through programs like PEPFAR." However, she did not include the 30 million by 2020 treatment target, nor did she agree to the clear funding ask we requested: a $2 billion annual increase by 2020. These treatment and funding targets have been agreed upon by experts in the US government, the AIDS advocacy community, and UNAIDS - and they are widely recognized as the targets necessary to successfully curb the epidemic before 2030.

She did promise in her updated statement to convene the 'End the Epidemic' working group to "adopt aggressive and attainable timelines for ending AIDS as an epidemic in the United States and globally". However, it is unnecessary for Clinton to wait for a working group to decide treatment and funding targets. There is already consensus on these targets, agreed upon by experts in the US government, the AIDS advocacy community, and UNAIDS. Over 80 organizations thanked her for her increased commitments, and asked her to make the concrete global commitments now.

There's no good reason not to. Clinton has committed to specific dollar amounts for other programs and initiatives, such as her $350 billion college plan, and to increase federal infrastructure funding by $275 billion over a five-year period. Compared to these laudable initiatives, a $2 billion annual increase for a highly successful program that she speaks of proudly should be a no-brainer.

A bold statement with treatment targets and concrete funding goals is especially critical right now, as the Kaiser Family Foundation and UNAIDS report that donor government funding to support HIV efforts in low- and middle-income countries fell for the first time in five years in 2015 by a billion dollars. UNAIDS Executive Director Michel Sidibé noted, "If we take our foot off the pedal, I am convinced that we will be unable to double the number of people on treatment again, and we will not see the major decline that we are expecting. Because of competing priorities, 13 countries out of 14 reduced their contribution to the HIV response globally. If this trend continues, we will have a rebound, not a reduction in incidence by 2030."

The Global Fund replenishment meeting is coming up in Canada on September 16, where donor countries pledge their funding levels for the next 3 years. The US must leverage the highest commitments from other countries by continuing to pledge funding one third of a fully- funded Global Fund. A statement from Secretary Clinton before this meeting begins, with her support for the highest commitment for the Global Fund, and a planned specific increase for the bilateral PEPFAR program, will demonstrate that the United States is not easing our foot off the brakes on reaching the end of the AIDS pandemic when it is in sight.

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