President Donald Trump’s proposed budget for fiscal year 2020 has, made public on 11 March, has contradicted the pledge he delivered in his February 2019 State of the Union address to increase spending on HIV. The budget, which proposes major cuts to the United States’ global health spending, includes a 29 percent reduction (compared to fiscal year 2019) in appropriations for the Global Fund, and has caused profound concern within the global health advocacy community. (The proposed cut to PEPFAR would be 22 percent.)
“My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years,” Mr Trump said in his February pledge. “Together, we will defeat AIDS in America and beyond.”
The proposed budget calls for a $1-billion cut to the United States’ three-year commitment to the Global Fund in the next Replenishment period.
“Any way you look at it, this is a devastating proposed cut,” said Chris Collins, President at Friends of the Global Fight. He explained that this budget proposes $1.1 billion for 2020 instead of the $1.56 billion advocates are seeking. The $1.56 billion level would be consistent with the U.S. continuing to provide 33% of resources to the Global Fund in the next replenishment cycle, assuming a $14-billion replenishment ($14 billion is the Global Fund’s official target). But the budget also calls for a change to the policy on this proportion, suggesting that the U.S. reduce its contribution to 25 percent of the Fund’s overall budget instead of the 33 percent it has historically maintained.
“This proposed budget is more than just a funding cut,” Collins said. “If enacted, it would signal a rapid retreat in U.S. global health leadership and would seriously undermine the Global Fund's replenishment.” Expanding on the idea that the President’s proposed budget “stands in stark contrast to his February State of the Union pledge to ‘defeat AIDS in America and beyond’,” Collins said, “We welcomed the President setting the goal of ending the global AIDS epidemic but his budget is totally inconsistent with that vision – it would actually take us backward in the fight against AIDS and risk resurgence of the disease around the world, because of cuts to proven and effective programming and health research.”
However, Collins said, “Let’s be clear, the White House budget does not represent the U.S. Global Fund replenishment pledge - Congress appropriates funding.” Collins said he is “confident that Congress will reject this attempt to undermine American leadership on global health”.
Other media reports on the proposed budget
Devex reported on the proposed cuts in the broader context of the U.S. Administration’s call for increased “burden sharing” (where other donors play a greater role) and proposed policy changes relating to the “reorganization” of U.S. aid. The Devex article also said that it is “widely expected that Congress will reject the administration’s proposal when determining its budget”.
The New York Times described the proposed cuts to PEPFAR and the Global Fund as well as to domestic health insurance programs Medicare and Medicaid, and cuts to safety nets for farmers, as making way for more military and border spending.
From the global advocacy community, Jen Kates, the Kaiser Family Foundation’s Vice President for global health and HIV policy told NBC News that “proposed cuts to the President’s Emergency Plan for AIDS Relief and the Global Fund, which fund treatment and prevention in poor countries, could work against the most well-intentioned efforts to end the HIV/AIDS epidemic.”
The U.S.-based Treatment Action Group said in a statement that the group opposed the President’s budget, which “makes a mockery of the administration’s purported strategy to end AIDS in the United States over the next decade”, and said that the budget’s “defunding” of other equally important areas including global health, social services and research “raises tremendous doubt about the administration’s commitment to end HIV.”
- “With Budget, President seeks retreat in U.S. global health leadership; would undermine Global Fund Replenishment,” from Friends of the Global Fight.
- “US budget slashes global development funding, stresses burden sharing,” from Devex.
- “Trump Lauded Farmers, Medicare and AIDS Programs. Then Came His Budget Knife,” from the New York Times.
- “Trump’s budget adds domestic HIV funding while slashing global outlays,” from NBC news online.
- “Experts React to White House FY2020 Budget Request Calling for Increase in Domestic HIV Funding, Cuts to Bilateral HIV Spending,” from the Kaiser Family Foundation.