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The end of AIDS is possible. Congress needs to fund it

Today marks the 34th observance of World AIDS Day. 

Approximately 650,000 people died of AIDS last year. That’s an AIDS death every minute, even though effective HIV treatment exists. While we remember those we’ve lost, we cannot and must not forget the policy decisions that led to our deep mourning. 

More than four decades into the HIV pandemic, there is no end in sight. This doesn’t have to be the case.  

Ground-breaking HIV treatment and prevention options exist. Heads of state and intergovernmental institutions have pledged to end this pandemic. And yet public policy has fallen short. People have continued to die needlessly over the course of a generation because policymakers’ actions do not match their words.

Mustering the political will to ensure universal access to lifesaving HIV treatment — and to end AIDS — remains a challenge. As this pandemic stretches on, our political leaders equivocate on funding the response. We cannot afford to skimp.

One in four people living with HIV around the world cannot access life-saving antiretroviral medicines. This figure is even more striking among children; only half receive the anti-retroviral care they need. This shameful treatment gap means children compose 15 percent of AIDS-related deaths, even though they are only 4 percent of people living with HIV. Flat funding disproportionately harms marginalized and criminalized people, who face additional barriers to accessing HIV prevention and treatment services. Over half of new infections occur among key populations, including sex workers, men who have sex with men, transgender people, people who use drugs, and people who are in detention.

We haven’t yet learned the lessons of the AIDS pandemic, and history is already repeating itself. 

COVID-19 has already killed approximately 15 million people while exposing and exacerbating the inequities that drive the AIDS pandemic, jeopardizing hard-won progress. Many of the communities already most impacted by HIV are also hit hardest by COVID — in the U.S. and around the world. Especially without treatment, people living with HIV are more likely to develop long Covid and more likely to die of mpox

To meet the moment, Congress and President Biden must prioritize PEPFAR in the budget for fiscal year 2023. At a bare minimum, Congress must pass $5.12 billion for this initiative. PEPFAR, or the President’s Emergency Plan for AIDS Relief, strives to control the HIV pandemic in more than 50 countries around the world. It has saved 20 million lives. For years, the mechanism received strong bipartisan support. President George W. Bush launched the program during his first term. The Obama administration introduced new prevention goals for PEPFAR. And Sen, Lindsay Graham (R-S.C.) and Rep. Barbara Lee (D-Calif.) have both championed the need to invest in this commitment, which leverages the expertise of seven federal agencies to address HIV worldwide. 

However, PEPFAR funding has flatlined over the past decade. And given inflation, this stagnant number translates to a decrease. With the current budget, PEPFAR and partners cannot fully meet community needs. They cannot utilize game-changing innovations like the new long-acting injectable HIV prevention medicines. With the status quo, we cannot reach new milestones in ending AIDS or slow the devastating pace of AIDS deaths. 

A budget of $5.12 billion will prevent further backsliding, but we need more in order to scale up access to lifesaving treatment so that everyone can benefit from scientific advancements.

In addition to funding initiatives that explicitly focus on HIV, Congress and the Biden administration must support pandemic preparedness and response for other health threats. After all, the past three years have reinforced that pandemics do not occur in isolation from each other or health systems at large. In this era of colliding pandemics, we must take a comprehensive approach to advance health justice. We need a plan for the management of long COVID, funding for a hub that builds mRNA capacity in low-and middle-income countries, and more money for the global response to COVID.

Investing in health is a matter of moral authority. It also helps strengthen national security and the global economy. This World AIDS Day, elected officials will offer statements on ending pandemics when what we really need is a federal budget that invests the resources to make those visions a reality. Congress can make this happen. Do they have the will? 

Alyson Bancroft, MPH is the Associate Director of U.S Policy & Advocacy at Health GAP. She serves on the Board of Directors for Universities Allied for Essential Medicines and previously worked at Public Citizen. 

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