PEPFAR Raided to Meet Global Fund Pledge in President Obama’s Fiscal Year 2013 Budget

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The Obama administration released its fiscal year (FY) 2013 budget today with a proposed $1.65 billion funding level—an increase of 57 percent over FY 2012 – for the Global Fund to Fight AIDS, Tuberculosis and Malaria to meet the U.S. pledge of $4 billion over 3 years.  This substantial and welcome budget request for the Global fund clearly came at the expense of PEPFAR, the U.S.’s flagship bilateral program which is slated for a stunning cut of $562.9 million—a reduction of more than 12 percent.   Global tuberculosis also saw a reduction of 10 percent, with a proposed budget request of $224 million compared to this year’s budget of $249 million.  On a more upbeat note, the President’s budget would restore language allowing the use of federal funds for lifesaving syringe exchange programs to reduce HIV and hepatitis transmission among injection drug users.

Global AIDS advocates who cheered President Obama when he announced new treatment targets for the PEPFAR program on World AIDS Day are now left to wonder how this is possible in a PEPFAR budget that was cut by the Congress by more than $90 million in the current fiscal year and faces a potentially draconian cut for the fiscal year beginning October 1, 2012.  It is well known that the Global Fund works hand in hand with the PEPFAR program frequently sharing the financing burden of providing HIV clinical care and antiretroviral drugs for the same communities.  Slashing the PEPFAR program to increase spending for the Global Fund would seem to undermine the promise of treatment scale up.

When asked about his thoughts on cuts to PEPFAR, Matt Kavanagh of Health GAP said, “Promising to put the world on the path to end the AIDS pandemic in December and then cutting half a billion dollars from bilateral AIDS programs in February is, at best, a bait and switch worthy of Wall Street.  In Zimbabwe where they’re facing waiting lists for treatment, in Malawi where there’s literally no external funding for ARVs past next year, and in Tanzania where we’re hearing clinics are refusing to enroll pregnant women above CD4 200, this is a disaster.”

Sharonann Lynch of Médecins Sans Frontières added that in light of the President’s World AIDS Day promise to place 6 million people on HIV treatment by the end of 2013, his new budget request proposes a “40 percent increase of people on ART with 10 percent less money.”

Below is a summary of key global health items in the FY 13 budget, provided by the Global Health Council.

  FY2013 Request FY2012 Enacted

% Change

MCH $578 million $606 million


   GAVI $145 million $100 million


TB $224 million $236 million


Malaria $619 million $650 million


NTDs $67 million $89 million


Pandemic Influenza $53 million $58 million


FP/RH $530 million $524 million


Nutrition $90 million $95 million


Vulnerable children $13 million $18 million


HIV/AIDS (USAID) $330 million $350 million


   IAVI $28.71 million    
HIV/AIDS (State) $3,629 million $4,243 million


   Global Fund $1,650 million $1,050 million


   UNAIDS $45 million $45 million


International Organizations
UNICEF $125 million $131.8 million


UNFPA $39 million $35 million


UN Women $7.9 million    

15 thoughts on “PEPFAR Raided to Meet Global Fund Pledge in President Obama’s Fiscal Year 2013 Budget

  1. Pingback: PEPFAR Raided to Meet Global Fund Pledge in President Obama’s Fiscal Year 2013 Budget | Knowledge of Medicine

  2. Kaleb Brownlow

    These types of arguments are a bit of a misnomer and distort reality. Many countries have significant financial pipelines that have not yet been spent and do not need to continue to receive massive amounts of money. Further, the Global AIDS community must advance how to be more efficient and do more with less. For too long, it has been to ask for hundreds of millions and billions of additional funds. Even though the 150 Account (International Affairs) represents a sliver of the budget, we cannot expect more and more money.

    The USG has also committed to using multilaterals (such as the Global Fund) to assume more responsibility for global HIV/AIDS programming. An increased funding to Global Fund should not be viewed as undermining the Global Fund.

    1. AIDS activist

      Thank you Ms. Lubinksi for the insights… this is a disaster.

      Re: previous comment: Curious if that’s an official response from USAID above Mr. Brownlow?
      A few facts you might have missed:

      -We have only reached just over 40% of those in need… so even where there are unspent monies (true in AIDS, also true in Medicare and the Recovery Act it should be noted) are you arguing that there’s 150% more funding than last just waiting in bank accounts?? In truth there is a massive funding gap.

      -Why should people living with AIDS get less? Are you really saying that what accounts as essentially a rounding error in the federal budget can’t be found this year?

      -The overall 150 account for International Affairs was INCREASED in the President’s budget by nearly 2%. So why did they cut PEPFAR by 10%?

      In truth this can only be taken as a signal from this administration–they are looking to pull out of responsibility and accountability that comes with the PEPFAR program and shift responsibility to Geneva so they can just complain about it from afar.

      This kind of budget is exactly the thing that many of the President’s supporters are so angry about: promises made with one hand and then dashed with the other.

      1. Youth Activist

        Not super psyched to see a USAID adviser saying the global AIDS community has been asking for more money “for too long.” Last time I checked, more money is actually what we all want, right? Or do you enjoy doing your job with no funding? Please let activists advocate and keep your socialized-for-scarcity arguments to yourself.

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