As the international community gets set to mark the 25th annual observance of World AIDS Day next week, President Obama is facing renewed pressure from U.S. lawmakers and activists to take legacy-setting action to combat HIV/AIDS.
A bipartisan group of 40 lawmakers earlier this month called on Obama to announce a new goal for the U.S. government to double its support of treatment of lifesaving anti-retroviral drugs by the end of his presidency through the President's Emergency Plan for AIDS Relief (PEPFAR), a program that is credited with providing millions of Africans with anti-retroviral drugs since its establishment and led to 1 million babies globally being born HIV-free.
In a letter, the lawmakers — led by Republican Sen. Tom Coburn of Oklahoma and Democratic Rep. Barbara Lee of California — made the case to Obama that "scaling up" to a goal of treating 12 million through PEPFAR "will not only save millions of lives but will also significantly reduce human suffering, new HIV infections, and healthcare costs in the years to come." The lawmaker called on Obama to set the new PEPFAR goal during an international conference in Washington set for next week, when donor countries will discuss the three-year replenishment cycle for the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Meanwhile, activists — including the South African social rights activist the Rev. Desmond Tutu — have challenged Obama to agree to pledge up to $5 billion to the Global Fund over the next three years. So far, the Obama administration has pledged up to $1.65 billion to the fund for 2014 on the condition that other countries contribute at least $3.3 billion. The 1-to-2 funding ration is set by Congress.
The White House plans to announce during next week's Global Fund conference that the administration has met the goal it set in 2011 of treating 6 million people through PEPFAR, but it won't set a new target until early next year, according to Gayle Smith, the senior director for development and democracy at the White House National Security Council.
"We've still got time before the replenishment conference kicks off and then the months after that when countries can continue to step up," Smith said. "We will set a new target and will continue to lead, and want our target to reflect what the global fund is going to do, what other donors and NGOs are going to do and, significantly, what [other] governments themselves are going to do."
Activists are also pushing Obama to quickly name a replacement for Ambassador Eric Goosby, who until last month served as the U.S. Global AIDS coordinator tasked with directing the U.S. strategy for addressing HIV around the world.
"The decisions that get made now will set the stage for the entirety of the Obama administration," said Tom Myers, general counsel for the AIDS Healthcare Foundation. "If come 2017, we live in a world where the number of people with HIV/AIDS is still increasing—given what we know can be done—that will not be a great legacy."
During his presidency, Obama has taken pride in distinguishing his foreign policy from former President George W. Bush. His backers note that Obama ended the war in Iraq, wound down the war in Afghanistan and the U.S. military captured Osama bin Laden under his watch.
But when it comes to fighting AIDS in Africa, activists and health care specialists say Obama has lagged behind Bush, who received praise from the political left and right as well as the international community by establishing PEPFAR in 2003.
Bush poured $15 billion into PEPFAR during his presidency. But since 2010, funding for PEPFAR has fallen 12%, putting the program at its lowest funding level since 2007, and the Obama administration has floated another $50 million cut in 2014.
Obama also faced criticism from the Global AIDS Alliance and other groups during the last replenishment of the Global Fund in 2010, when the Obama administration pledged $4 billion over three years. Activists said that the U.S. was punching below its weight, and led to other donor countries holding back funding.
On the domestic front, Obama was credited with introducing the National HIV/AIDS Strategy -- a road map to reduce HIV infections, bolster treatment and decrease HIV-related health disparities in the United States.
But Myers also noted that the wait lists for the AIDS Drug Assistance Program (ADAP)— the main spigot of domestic funding for HIV care for low income HIV positive Americans—numbered in thousands. As the economy floundered in 2010, the government couldn't keep up with the spike in demand caused by people losing their jobs and health insurance, leading to low-income HIV-positive Americans being turned down for care.
"Given those facts, the administration has not prioritized HIV and AIDS epidemic like the Bush administration," Myers said. "We could be a lot further along than we are now."
Obama has chafed against the oft-repeated notion from some AIDS activists that he has lagged Bush in fighting the spread of AIDS.
During his first presidential visit to Africa earlier this summer, Obama defended his record, and noted that the budget restraints he's face during his presidency make it difficult for him to wring out more money from the GOP-led House.
"We are serving four times the number of people today than we were when PEPFAR first began, but because we've gotten better at it and more efficient at it, we're doing it at reduced costs," Obama said.
In November, just weeks after Obama was reelected to a second term, then Secretary of State Hillary Clinton unveiled a "blue print" for what she called an AIDS-free generation. Obama repeated in his State of the Union address that he believed the goal was "within our reach."
Over the past decade, the rate of new HIV infections has dropped by more than half in 25 low- and middle-income countries, most of them in sub-Saharan Africa, as PEPFAR and other programs have helped millions gain access to anti-retroviral drugs, according to UNAIDS.
Activists say the world is at the door-step of virtually eradicating AIDS over the next generation, but it requires Obama to act boldly.
"When Obama made a pledge to reach for an AIDS-free generation, that was huge," said Paul Zeitz, vice president of policy for the Endgame Campaign, a group working to eradicate AIDS, tuberculosis and malaria. "Now is the president's chance to say what it all means. This is his crucial moment."