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March/April 2011
Vol. 36, No. 2

QDDR, the Global Health Initiative and AIDS

The First Quadrennial Diplomacy and Development Review (QDDR), issued by the State Department in December 2010, is the result of a wide-ranging consultation that examined U.S. diplomacy and development policies and practices "to make them more effective and efficient." The QDDR identifies the Obama administration's Global Health Initiative (GHI) as one of the six main areas of focus (others are food security, sustainable economic growth, climate change, democracy and governance and humanitarian assistance). It emphasizes structural change; relies on host countries' systems and organizations; and concentrates in countries where U.S. assistance can make a difference.

Some of the insights and commitments included in the QDDR, if implemented, could enable the United States to play a much more positive role in the world: the QDDR describes a more balanced approach to U.S. foreign policy, emphasizing the importance of diplomacy, development and civilian leadership and possibly taking a small step away from a militarized U.S. foreign policy; it identifies the need for systemic change; and suggests the possibility of multi-year budgeting and procurement reform – "fostering more competition for our contracts and using host-country businesses and NGOs where possible."

However, the QDDR and GHI's emphasis on results and efficiency may eliminate or drastically reduce key programs without sufficient transition time or attention to the unique needs of the 33.3 million people worldwide living with HIV or AIDS.

In 2003, President Bush announced the President's Emergency Plan for AIDS Relief (PEPFAR), a $15 billion program to fight AIDS over five years in 15 focus countries. Between 2004 and 2008, the U.S. contributed nearly $19 billion to fight AIDS.

In 2008, Congress passed authorizing legislation that would continue PEPFAR for five years. The commitment, based initially on a campaign pledge of $50 billion over five years by then-candidate Obama, included $48 billion over five years to fund AIDS, tuberculosis, malaria, microbicides development, health systems strengthening, training and retaining 140,000 new health workers and many other programs.

The GHI is a six-year, $63 billion comprehensive approach to global health problems that, according to the Congressional Research Service, builds on the Bush administration's focus on global HIV and AIDS, tuberculosis and malaria, but prioritizes building strong and sustainable health systems through an emphasis on maternal and pediatric programs as well as strategic coordination.

Many AIDS activists have expressed concern about the shift in focus. Since 2009, the U.S. has not increased funding for global AIDS enough even to keep up with inflation. Further, the determination of many Congressional newcomers to reduce the deficit and control government spending will make it more difficult to secure increased global AIDS funding either bilaterally or through the Global Fund. Other nations have followed suit; funding for HIV and AIDS programs has not increased in recent years.

A February 2011 UNAIDS report, Universal Access to HIV Prevention, Treatment, Care and Support: From Countries to Regions to the High Level Meeting on AIDS and Beyond, writes that AIDS advocates have their biggest challenge yet: "Successes of the past few years have in many places led to complacency, just as our efforts are beginning to pay dividends. The development landscape and global economic crisis have shifted, with funding for AIDS flat-lining or even decreasing, all against a backdrop of already crowded competing global priorities, such as climate change and other Millennium Development Goals. In places where the epidemic had stabilized or decreased infection rates are increasing again, and discrimination, punitive laws and gender violence are increasingly undermining efforts to improve access to services for key populations."

While in the long term, strengthening national health care capacities may be the right way to go – until people living with HIV or AIDS can rely on local systems for the support they need or have guaranteed access to locally produced, affordable medicines – the moral and ethical imperative to care for human life has to take precedence over efficiency and effectiveness.

Faith in action:

On Feb. 17, Rep. Pete Stark (D-CA), ranking member of the House Ways and Means Committee, re-introduced the "Investing in Our Future Act" (HR 755) for 2011. It would place a .005 percent levy on currency exchange by large scale investors and big banks, and generate billions of dollars for global health. It would specifically fund the Global Fund to Fight AIDS, TB, and Malaria as well as other multilateral global health efforts. (See NewsNotes September-October 2010 for more information about financial transaction taxes). Contact your Congressional representative and encourage him or her to co-sponsor the Stark bill.

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