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U.S. increase in AIDS funds is crucial

Saturday, December 19, 2009; A16

The Dec. 13 editorial "An AIDS mission renewed" defended the Obama administration's decision to maintain rather than increase funding levels of the President's Emergency Plan for AIDS Relief (PEPFAR).

The administration's support for HIV prevention doesn't replace the need for significant increases in resources for treating people living with AIDS. And the call for greater responsibility on the part of recipient countries cannot be used as cover for backtracking on commitments to universal access to treatment.

PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria are essential to sustain and increase access to AIDS treatment in developing countries. The Global Fund needs billions of dollars. Now the White House has frozen bilateral AIDS funding in 2009 and 2010 and has signaled it will do so in 2011.

The consequences are apparent. Our teams on the ground see other health providers who ration treatment and are advised not to treat new patients unless current ones die or disappear. Countries are reducing treatment targets and people are at risk of treatment disruption. This comes at a time when new World Health Organization guidelines call for people with HIV to begin treatment earlier.

AIDS is still a medical emergency. The disease is the leading cause of death of women of reproductive age. It kills more babies than any other cause in Swaziland, Botswana, Lesotho, Zimbabwe, Namibia and South Africa. In the United States, a young person on HIV treatment can expect to live to age 69. What was a death sentence is now a manageable disease. We can't go back to letting poor people die when lifesaving treatment is available in rich countries.

Sophie Delaunay, New York

The writer is executive director of Doctors Without Borders-USA.

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The Post was right to point to the many important policy advances in the new five-year President's Emergency Plan for AIDS Relief released last month. We commend Ambassador Eric Goosby, the U.S. global AIDS coordinator, and Secretary of State Hillary Rodham Clinton for a strategy that seeks to broaden health service delivery and combat stigma.

But The Post's editorial minimized the impact of flat-lining PEPFAR funding. This approach would have serious negative consequences, slowing the planned scale-up of HIV/AIDS treatment and prevention when millions are in urgent need of care and the epidemic continues to grow around the world.

The administration's forthcoming Global Health Initiative can't succeed if it treats global health as a zero-sum game. We need to expand upon our enormously successful investments in global health, not shift resources from one priority to another.

Chris Collins, Washington

The writer is vice president and director of public policy for the Foundation for AIDS Research.

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