Advancing Country Partnerships on HIV/AIDS

Executive Summary


U.S. investments to tackle HIV/AIDS by the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund) have saved millions of lives and enabled us to see how the world might bring an end to AIDS as a major public health burden. As the largest funder of HIV/AIDS programs, the United States has driven the progress made so far, but others have also made important contributions. The achievements of PEPFAR and the Global Fund over the past 15 years have been built on strong country partnerships. U.S. engagement has strengthened the leadership capacity of governments to fight the HIV epidemic and energized a host of nongovernmental players—including civil society groups, faith-based organizations (FBOs), and private-sector representatives—to join the effort. In the process, many PEPFAR and Global Fund partners have assumed leadership—and greater financial responsibility—for their HIV/AIDS programs, putting in place the foundations of a sustainable response.

President Trump’s proposed FY 2018 budget calls for steep declines in global HIV/AIDS funding and other health programs in many countries that benefit from PEPFAR’s presence. Precipitous withdrawals of funding and technical assistance risk undermining, even reversing, hard-won gains. The proposed budget cuts call into question the ability of the United States to sustain progress on HIV/AIDS and could disrupt efforts to encourage country partners to assume more leadership of their own responses to the epidemic. This outcome would not be in the national interest of the United States; it would undermine years of U.S. global health investments and risk a resurgence of the HIV epidemic in countries where intensified efforts could bring epidemic control within reach by 2020. The United States should help countries put the foundations in place for a sustainable HIV response, including ambitious but realistic plans to grow their economies and increase the share of domestic revenues allocated to health. Only then will it be possible to negotiate transitions away from front-line support without putting lives at risk.
Photo credit: Brent Stirton/Getty Images

Richard Downie