Subject: SFRC hearings on AIDS + Prof. Jeff Sachs testimony

1. Note on Wed & Thursday Senate Foreign Relations Committee hearing on
international AIDS crisis
2. Text of Professor Jeffery Sach's testimony (also attached)

Thursday's SFRC Africa Subcom hearing was both moving and disappointing in a
number of ways.

The CDC and USAID were asked a number of good questions about provision of
treatment. CDC mentioned they had received millions of dollars in FY2001
to implement 'pilot' ARV programs, but were still "assessing the capacity"
to do so.

If that was not shameful enough, when asked about how much it would cost to
treat people in poor countries or to scale-up existing programs, both of the
government reps scratched their heads. Anne Peterson from USAID said "I
don't think anyone has ever costed out" the provision of treatment. After
some stuttering, she then muttered "probably billions".

This was an embarrassing disclosure, displaying ignorance of years of peer
reviewed data in Science, the Lancet, or from WHO, UNAIDS and World Bank.

Doctors Jim Kim and Jeff Sachs gave tremendously strong testimony, and
many in the room were visibly moved - especially by a full house
condemnation of the immoral and inaccurate specious nonsense we have
previously heard about 'cost effectiveness' of providing treatment.

However, due to the Senators being summoned for votes, the hearing was
interrupted and compressed, and without question periods. Therefore, none
of the panelists were able to raise the 'ask' for $1.2B for the GFATM or
for $2.5B total spending for global AIDS FY 03, nor for an emergency
supplemental request for FY 02 to enable the fund to succeed this year,
rather than hobbling it with underfunding.

Also cut off was an effort to convey a few facts about the situation of
the GFATM in March and April. At this week's hearings, even some of our
strongest champions were not aware or fully informed of the upcoming
calendar of applications, and rigorous technical review, or the first
disbursements occurring in NYC at the end of April.

The Wednesday hearing was notable for consisting of a little too much
backslapping on the adequacy of the US contribution to the GFATM, where
members pretended that the United States does not set the bar under which
other countries determine their own contributions.

Natsios and Thompson's pro-treatment comments were a relief after some
disastrous presentations made last year.

Attached (and pasted below) is the Sachs testimony. The written version
_does_ mention a supplemental request. We believe this will be the only
way to move serious money this year. Given the rapid destabilization the
AIDS crisis is creating in Africa and Asia, there seems to be some
plausible movement towards using the GFATM to leverage money _this_ year. It
is critical to correct the catch-22 situation created by the (appropriate)
pressure to deliver dramatic results hamstrung by underfunding.

Below my contact info is the text of the written submission by Dr. Sachs
(which is also an attached document.)

Online videos of both Senate Foreign Relations committee hearings
on Global AIDS 2/13 and 2/14 are now up on the Kaiser network site. The
latter has testimony by Dr. Jim Kim and Dr. Jeffrey Sachs. Transcripts
should be up soon as well. Click here:

http://www.kaisernetwork.org/health_cast/hcast_index.cfm

Best,

Paul Davis
[email protected]
Health GAP Coalition
ACT UP Philadelphia

+1.215.833.4102 mobile
+1.215.474.6886 tel.
+1.215.474.4793 fax
-------------

Testimony of Prof. Jeffrey D. Sachs

Not one person in the developing world has yet received donor-supported
antiretroviral therapy!

Committee on Foreign Relations of the United States Senate
Subcommittee on African Affairs

"African HIV/AIDS Crisis: Pursuing Both Treatment and Prevention"
February 14, 2002

Testimony of Prof. Jeffrey D. Sachs

Chairman, WHO Commission on Macroeconomics and Health
Director, Center for International Development, Harvard University

Senators,

Thank you for the opportunity to testify today regarding one of the most
urgent problems facing humanity ­ the global AIDS pandemic. The decisions
that the Congress and Administration make regarding the pandemic will
determine the life or death of millions of people in the next few years, and
will affect America¹s security and standing in the world for decades to
come. To date, the United States and other donor countries have
under-financed AIDS control in poor countries. This has allowed the
pandemic to run rampant. Millions of poor people are needlessly dying every
year when their lives could be extended by appropriate medical care at
modest cost and enormous benefit to the United States.

Last month, I visited some of the dying fields of Africa. I stood in Queen
Elizabeth Hospital in Blantyre, Malawi where 70 percent of the medical
admissions are AIDS-related. Hundreds of patients are crowded into the
wards to die, two or three to a bed, with patients also lying on the floor
under the beds. Hospital services are collapsing under the weight of the
epidemic. There are no life-saving drugs given to these people because
neither the dying patients nor the Government of Malawi can afford the
medications.

Yet across the hall, an outpatient service successfully treats the small
fraction of HIV-infected people who can afford one dollar per day. Hundreds
of people are successfully on antiretroviral therapy. The problem in this
hospital is not infrastructure, doctors, testing equipment, adherence by
patients, the ability to tell time ­ it is simply the shortage of $1 per day
per patient that would supply life-saving drugs. Even when one adds in the
testing and counseling costs in addition to the direct costs of drugs, it is
very likely that total spending would remain well under $3 per person per
day.

While the stain of U.S. neglect during the first 20 years of the pandemic
can never be washed away, it is not too late to act, for our direct security
needs as well as our moral purpose as a great nation. The most important
step is for the U.S. Government to get organized to help lead the global
war against AIDS. Currently, the Government lacks: clear organizational
lines of responsibility (with responsibilities divided among several
Departments and agencies without any clear leadership); a long-term strategy
for a scaled-up war against AIDS; and a multi-year budget strategy
commensurate with global needs (and even lacks a single serious study of the
budgetary outlays that will be required). The Administration is moving
reactively, not proactively. It is picking levels of budgetary support
(such as $200 million in FY03 for the Global Fund to Fight AIDS,
Tuberculosis, and Malaria) out of the air, not out of a strategy.

In addition to better organization, the United States should increase its
spending on AIDS control by contributing at least $2.5 billion in FY03 to
control of AIDS in poor countries, of which at least $2 billion should go
the Global Fund, for the reasons described below. Our contribution of $2.5
billion to AIDS control should be matched by at least $5 billion from Europe
and Japan, for a total outlay of $7.5 billion for HIV/AIDS control. The
Global Fund should disburse at least $6 billion for AIDS, tuberculosis, and
malaria in FY03.

The Global Fund has $700 million available for disbursements in 2002, of
which the U.S. share is $250 million. The Congress and the Administration
should agree to a supplemental appropriation of at least $750 million for
FY02, to raise the U.S. contribution this year to $1 billion. This in turn
should be matched by at least $2 billion from Europe and Japan, for a total
of $3 billion. Without this supplemental appropriation, the Fund will either
run out of money during the year, or will drastically ration the size of
programs that it approves, to the serious detriment of disease control
efforts.

Scale of Financial Assistance for HIV/AIDS Control in Poor Countries

Table 1 breaks down the financing of AIDS control in recent years, and
estimates the needs for U.S. contributions for AIDS and for total disease
control efforts in poor countries in the coming years.

In the second half of the 1990s, America spent around $10 billion
dollars per year battling the AIDS epidemic at home, but only around $55
million per year in helping Sub-Saharan Africa to battle the epidemic. For
all developing countries, spending on AIDS was around $120 million per year.
It is worth recalling that the U.S. has about 1 million HIV-infected
individuals, while the developing world has 38 million infected individuals.
Treatment costs, I will note below, are of course much lower in the poor
countries, but the combination of prevention and treatment costs will still
require vastly higher donor assistance to meet the needs of the tens of
millions of individuals already infected and the hundreds of millions that
are at risk of infection.

U.S. international assistance to fight AIDS has recently begun to increase,
to around $690 million in FY02 (not including around $188 million in NIH
research funding), with perhaps two-thirds of that aimed at Africa
(depending, for example, on allocations from the new Global Fund to Fight
AIDS, TB, and Malaria). The FY03 budget request again increases the total
international spending on HIV/AIDS to around $895 million (not including
$222 in NIH research funding), with $200 million requested for the Global
Fund. While these recent spending increases are certainly in the right
direction, U.S. assistance is still woefully short of any realistic sum
needed to help the poorest countries, especially in Sub-Saharan Africa,
fight the AIDS pandemic.

Secretary General Kofi Annan has called for $7 to $10 billion per year for
the control of AIDS in low-income countries, an estimate that has been
supported by several expert studies, published in the world¹s leading
journals, such as Science Magazine (Schwartlander, et. al., 2000) and
elsewhere. Looking out a few years, the worldwide need for donor assistance
to control AIDS will probably be at the high end, perhaps reaching $10-15
billion depending on the course of the epidemic, the evolution of treatment
costs, and ability of the low-income countries to scale up AIDS control
efforts.

In the past two years, I chaired the WHO Commission on Macroeconomics and
Health, which was charged in part with determining donor financing needs to
address the interlocking pandemics of AIDS, malaria, tuberculosis, and other
killer diseases. Our study, released in December 2001, determined that
Sub-Saharan Africa would need total donor assistance for health of around
$18 billion per year as of 2007, of which more than half would be devoted to
the control of AIDS, with the rest directed at other killer diseases such as
tuberculosis, malaria, vaccine-preventable diseases, respiratory infections,
and diarrheal diseases. Since other regions would also need donor
assistance to fight AIDS, the worldwide need for donor assistance to fight
AIDS could reach $10-15 billion per year by 2007.

Since the U.S. represents around 40 percent of the GNP of the donor world
($10 trillion out of $25 trillion in total donor GNP), the U.S. share of the
total health assistance will need to be at least one quarter of the total,
if not more. This means that U.S. spending on AIDS in Africa will require
at least $2 billion per year, and total U.S. foreign assistance for AIDS
should reach at least $2.5 to $3 billion per year worldwide in FY03.
According to the Report of the Commission, total worldwide donor spending on
all types of health programs should be approximately $27 billion per year by
2007, so that total U.S. health assistance would be in the range of $7 - $8
billion per year, roughly five to six times the current level.

These numbers may seem large, Senators, but the amount of suffering and
global risk posed by the pandemic diseases is far greater. The Commission
findings suggest that if the U.S. invests on the order of $7 ­ 8 billion per
year as part of a global program of around $27 billion per year as of FY07,
around 8 million deaths will be averted each year by the end of the decade.
We can save 25,000 people every day from deaths due to AIDS, malaria,
tuberculosis, and other killers if we put our minds, and a modest part of
our incomes, to it. Note that $7 to 8 billion per year for global health
needs would represent far less than one half of one percent of our national
budget, and less than one penny out of every 10 dollars of our income.

The United States, while the second largest donor in absolute terms
(after Japan), has become the smallest donor in the world when aid is
measured as a share of income! (Chart 1). We are now spending only 0.1
percent of GNP on all forms of official development assistance, compared
with an average of more than 0.3 percent of GNP in Europe. The oft-repeated
excuse that ³aid does not work² is a cruel abnegation of U.S.
responsibility. We must stop talking about ³aid² in generic terms, and
start discussing targeted financial support for specific health
interventions ­ such as prevention and treatment of AIDS, increased coverage
of immunizations, wider dissemination of anti-malaria bednets, and the like.
History demonstrates that such targeted interventions have a high success
rate. From the expanded program on immunization (EPI); to the campaigns
against smallpox, polio, African river blindness, and trauchoma; to the
spread of oral rehydration therapy; directly observed therapy short-course
(DOTS) for tuberculosis, and insecticide-impregnated bednets, foreign
assistance for health has worked well. Unfortunately, the level of aid has
always been tragically meager compared with the level of need.

Donor support for Anti-Retroviral Therapy in Poor Countries

Life-saving antiretroviral combination therapies have been available
since the mid-1990s. Yet given the low levels of donor assistance, the
stunning fact is that not one person in the developing world ­ out of the
more than 60 million who have been infected by the HIV virus since 1981 ­
has received such drugs through official donor support from the U.S. or any
other country or multilateral institution. Let me repeat that, Senators.
Not one person in the developing world has yet received donor-supported
antiretroviral therapy! The U.S. and other leading donors have so far
turned their backs on millions of dying people. This dreadful fact is
supposed to change, finally this year, when the Global Fund and USAID both
begin to support the introduction of antiretroviral therapy. Yet the donor
sums so far committed in 2002 will permit only a very small scaling up of
treatment relative to the enormous needs.

For many years it was casually supposed that antiretroviral treatment was
too expensive for low-income countries. Drug regimens cost $10,000 or more
per year in the United States. But it has come to be understood that the
prices of antiretrovirals in the U.S. are vastly higher than the actual
production costs, which are probably on the order of $300 - $750 dollars per
regimen per year, depending on the precise combination of medicines. The
high margin of the price over marginal production cost reflects the returns
on research and development, a margin that is properly protected by patent
rights. Yet, the lower production costs make it possible to provide the
low-income world with the drugs at the actual marginal cost of production,
close to $1 per day for the least expensive combinations. The leading
pharmaceutical companies, and high-quality generic producers that have
access to the African market (which has little patent coverage for most of
the relevant drugs) have shown their readiness to provide drugs at the much
reduced prices. Still, the impoverished countries in Africa require donor
assistance even to cover the costs of $1 per day for the drugs (and perhaps
another $1 per day on average for the accompanying testing and medical
care).

A high-end estimate is that anti-retroviral treatment will require
around $1,000 per patient per year in low-income settings, including the
costs of drugs, testing, and medical care. This can probably be reduced to
around $500 per patient per year with further reductions in drug prices, and
optimized regimens regarding testing and medical care. Of the 25 million
Africans currently infected with HIV, perhaps 4 to 5 million would qualify
for highly active antiretroviral therapy on clinical grounds. Of these, it
is estimated that perhaps 25,000 ­ 50,000 are currently receiving the
medicines, while the rest are dying. Even those receiving the medicines are
often on sub-optimal regimens, with interruptions of drug availability,
inadequate drug combinations, and poor monitoring.

UNAIDS, WHO, and other expert groups that have looked closely at this
believe that 5 million people in low-income settings, mainly in Africa,
could be on successful antiretroviral therapy within 5 years. Indeed, the
numbers could be even higher is scaling up is given adequate support. That
would suggest a total cost of around $5 billion per year for antiretroviral
treatment by FY07, plus the costs of prevention programs and treatment for
opportunistic infections, thereby arriving at the cost estimate of $9 ­ 12
billion of donor support by FY07.

The Global AIDS Pandemic and U.S. Security

Let me briefly address the highly adverse foreign policy implications of
the AIDS epidemic for the United States, and then discuss the importance of
scaling up treatment, including anti-retroviral therapy, to control the
epidemic.

AIDS is destroying the prospects for African economic development and
democracy

The greatest hope for democracy and economic progress in Africa remain our
friends such as South Africa, Nigeria, Botswana, Ghana, Mozambique, Malawi,
and Tanzania. These nations, among many others in the region, are being
ravaged by AIDS. Foreign investment has been seriously impeded as investors
avoid countries where a significant proportion of the labor force is likely
to be HIV-infected. It is not poor villagers alone who are dying: an entire
educated and professional class is disappearing. The labor force, including
the most highly productive age groups, is being wiped out. Sub-Saharan
Africa now has 25 million HIV-infected individuals, roughly 9 percent of the
adult population between the ages 15 and 44. More than two million Africans
are dying of AIDS each year. In Southern and Eastern Africa, the prevalence
is well above 10 percent, and in hard hit countries, 25 percent or more.
AIDS has become a dire and fundamental impediment to economic progress in
Africa and leaves an even more troubling legacy: tens of millions of
orphaned children.

AIDS is creating a demographic catastrophe, with profound security risks

AIDS has already left behind more than 12 million orphans, and
epidemiological estimates suggest that the number could rise to 40 million
by the end of the decade unless the pandemic is staunched. As America lets
millions of African die for want of $1 per day in medicines, millions more
children are left orphaned. Common sense and repeated studies have shown
that these children are at great risk of hunger, neglect, withdrawal from
schooling, crime and violence.

AIDS is creating a breeding ground for terrorism

Disease is repeatedly found to be one the most powerful predictors of state
collapse and internal violence. The CIA Task Force on State Failure
identifies high infant mortality rates as one of the three most powerful
predictors of subsequent state failure (in addition to lack of democracy and
lack of open economy). Furthermore, AIDS is decimating adult populations
and increasing the percentage of populations which are aged between 15 and
24. Research has determined that such demographic shifts are a major
predictor for the outbreak of conflict.

AIDS is fomenting a social and political backlash against the United States

Throughout Africa and the developing world, people believe that they have
been left to die by America. They are aware that life-saving drugs exist to
save them, but that those drugs are not being made available. Conspiracy
theories abound in Africa that AIDS is a deliberate policy of genocide by
the United States, or an accident of the CIA gone awry. These desperate
flights of fancy aside, our actions to date point to one conclusion:
America judges African lives to be worth less than $1 or $2 per day.

AIDS is threatening China and India and other parts of the world

What has come to Africa will soon be true in the populous centers of Asia,
including India and China, where the epidemic is still in its early stages.
The destabilization that could arise from full-fledged epidemics in those
countries is harrowing. We must not ignore the central truth about
epidemics: they are far less costly to control at an early stage.

AIDS is threatening U.S. public health

AIDS originated in Africa, probably West Africa, sometime around 1930
according to the best current estimates. It went undetected for decades, in
part because of the remarkably poor state of public health surveillance in
Africa, and was only identified as a new disease in 1981 after it had spread
to the United States. In this sense, AIDS is precisely the kind of threat
of cross-border transmission of infectious diseases that public health
officials have warned us about for decades. Our neglect of burgeoning
infections abroad ­ whether from AIDS, or tuberculosis, or other new and
rapidly evolving viral and bacterial conditions ­ poses stark risks to
American public health. The day has already arrived when any one of us
could, during a flight or in a theater, be infected with multi-drug
resistant tuberculosis, the treatment of which involves two years of
chemotherapy. AIDS is also evolving rapidly, and there are reasons to
suspect that some viral subtypes may be more transmissible and virulent than
others. New forms of the disease in Africa or elsewhere, especially if
uncontrolled, will readily jump to the United States with dire consequences.
Thus, we must act decisively not only because it will save lives abroad; it
will save lives here at home as well.

Designing a Control Strategy that Can Meet the Challenge of a Global
Pandemic

AIDS requires a comprehensive strategy, including both prevention and
treatment

The most pernicious myth of donor policy has been that prevention alone,
without treatment, will control the epidemic. This view is brutally
shortsighted and fundamentally flawed. Both prevention and treatment are
necessary. In the Report of the Commission on Macroeconomics and Health, we
concluded that total spending on AIDS should fall into three roughly equal
categories: prevention programs; treatment of opportunistic infections; and
antiretroviral therapy.

Anti-retroviral therapy is necessary for two basic reasons. First, we
cannot afford to allow millions of working-age Africans -- mothers and
fathers and core members of the labor force -- to die for lack of $1- 2 per
day in medicines and treatment costs, given the enormous resulting losses in
economic development, the millions of orphans that would be left behind, and
the resulting threats of violence, political destabilization, and social
upheaval. It is just dreadful economic miscalculation to believe that it is
³cost effective² to stand by and allow a generation to die for lack of $500
- $1000 per patient per year for medicines and ancillary care.

Second, treatment is vital for successful prevention. In the United States,
the Centers for Disease Control terms antiretroviral treatment a form of
³secondary prevention.² The availability of treatment encourages people to
get tested for HIV infection, and then to receive counseling if they are
infected. Yet in Africa, where testing is not now followed by treatment,
individuals rarely seek testing and counseling, and it is estimated that
fewer than 5 percent of HIV-infected individuals actually know their status.
Without counseling and testing, one of the key methods of limiting
transmission is lost.

The benefits of treatment for prevention go well beyond encouraging
counseling and testing. Stigma is reduced when the disease is known to be
treatable, and the disease can be addressed in much more direct and sensible
manner. Irrational and often highly destructive social interpretations of
the disease (e.g. that it is a form of witchcraft, or a CIA form of
bioterrorism, or that it can be cured by having sex with a virgin) are
diminished as soon as successful medical interventions are demonstrated.
Politicians stop hiding from the epidemic when they can offer hope to their
populations. Medical staffs, currently unable to save their dying patients
for want of medicines, are re-energized to fight the epidemic.

Treatment is feasible at a greatly enlarged scale

Physicians experienced in Africa know that treatment can be successfully
scaled up dramatically. Many doctors in Africa and other resource-poor
settings are already successfully treating patients, but only the small
proportion who are able to purchase the drugs out of pocket. With concerted
financial support, training to African medical personnel could be expanded
dramatically; testing facilities could be expanded or created; and new
protocols could be elaborated to ensure a reliable flow of drugs and high
patient adherence to drug regimens. WHO and UNAIDS estimate that at least 5
million patients in low-income settings could be on anti-retroviral therapy
by the end of 2006.

The Global Fund is the best single investment for the United States in AIDS
control

The Global Fund to Fight AIDS, Tuberculosis, and Malaria is an important new
weapon in the fight against AIDS. The Fund was formally launched in January
2002, and will receive the first round of proposals by March 10, 2002.
Initial funding is likely to begin by late April.

The Global Fund has several key strengths.

(1) The Fund will be the key source of multilateral grant financing for AIDS
control in low-income countries, especially since the World Bank is still
hamstrung in making loans rather than grants for AIDS control efforts in
low-income countries;

(2) The Fund effectively pools donor resources, so that countries can create
a comprehensive strategy and apply to one single source of financing, rather
than to twenty or more distinctive and often contradictory assistance
programs supported by individual bilateral donors;

(3) The Fund leverages U.S. funding by encouraging donor support from
Europe, Japan, and other high-income countries. The initial U.S.
contribution of $300 million combined in FY01 and FY02 has now been matched
by at least $1.5 billion from other donors. While the total sums are still
far too low, the leveraging of U.S. aid is clear;

(4) The Fund offers Congress and the international community a transparent
mechanism for monitoring the flow of funding proposals and funding
decisions, thereby helping to ensure that donor funds are disbursed in a
sensible and evidence-based manner. One of the strongest features of the
Global Fund is that proposals will be vetted by an independent expert review
committee;

(5) The Fund is already spurring initiative at the grass roots (including
local non-governmental organizations), as well as increased collaboration
between governments and civil society;

(6) The Fund will enable selectivity in the choice of programs and countries
that will be funded, so that funds can be held back from corrupt governments
and inappropriate programs;

(7) The Fund will enable improved monitoring and auditing of the actual use
of donor funds.

(8) Programs supported by the Fund can and should include financing for
operational and clinical research linked to the provision of health
services. The Fund can be an important vehicle for financing the research
necessary to optimize treatment protocols.

Research Efforts Should Be Intensified

The U.S., through the National Institutes of Health, is already the world¹s
leader in basic research in AIDS. This leadership should be maintained and
enhanced, with increased research contributions from other donors as well.
Recent advances in vaccine research suggest that an effective vaccine may be
available within a decade, if not sooner. There will need to be
considerable coordination across countries in the basic research, product
development, and clinical testing, to speed the process. The International
AIDS Vaccine Initiative, among others, has already made important strides in
this area, and work by IAVI and others should be supported by the U.S.
Government.

In addition to basic research on the immunology and pathophysiology of
AIDS, and applied research on vaccines and therapeutics, the U.S. should
actively support clinical and operational research into treatment protocols,
as well as epidemiological and behavioral research related to the
transmission of the disease on the population level. The Fogarty Institute
at the National Institutions of Health can play a key role in strengthening
the capacity of poor countries to carry out clinical and operational
research, in programs such as the awards for International Clinical,
Operational, and Health Services Research (ICOHRTA). The Centers for
Disease Control can play a key role in helping countries with the
epidemiological and behavioral research, as well as surveillance studies.

Immediate Steps

Budgetary outlays of $2.5 billion FY03

The Congress and Administration should support a U.S. contribution to AIDS
control of at least $2.5 billion in FY03, of which the Global Fund should
receive at least $2 billion, compared with the Administration¹s request of
$200 million. The $500 million minimum of additional funding should support
programs of USAID, NIH, and CDC.

Supplemental budget in FY02

Congress and the Administration should be prepared to make a supplemental
appropriation for the Fund during FY02 of $750 million, raising the FY02
U.S. contribution to $1 billion.

Bi-partisan Congressional Mission to Africa during this Spring

Given the urgency of the global AIDS pandemic, and the role that the
U.S. must play to overcome it, it is critical for Congressional leaders and
staff to understand the crisis on a first-hand basis. Much of what is
reported, especially the alleged obstacles of effective treatment in the
African context, does not reflect on-the-ground reality. Moreover, the
sheer scale of the crisis is difficult to fathom without a first-hand view.

For this reason, I strongly urge that the Congressional leadership
appoint a bi-partisan mission to travel to Africa and to report back to the
Congress this Spring. The claims and counter-claims can then be evaluated
directly, and the shocking enormity of the crisis will better be brought to
the American people through their Representatives in Congress.

The Opportunity

The United States has missed an enormous opportunity during the past two
decades to establish global leadership in quelling the AIDS epidemic. It¹s
been an opportunity to not only save lives and make a contribution to the
global economy; it¹s been an opportunity to promote enormous good will
towards our nation, to shore up democracy and economic growth, and to lessen
the threats posed by destabilized states.

I come today bearing one message: today is not too late to act. While
millions have died and instability has grown, we can still avert the worst.
Senators, in our lifetimes our children and grandchildren will ask us what
our country did during the worst epidemic to strike humankind. With your
leadership, I hope that we shall be able to offer a response that makes us
all proud to be Americans.
Table 1. Estimated Budgetary Outlays and Needs for AIDS and All Disease
Control
FY95-99 FY2000 FY01 FY02 FY03 Estimated Need FY07
U.S. AIDS Spending Domestically $10 billion $10
billion $10 billion $11 billion $12 billion

U.S. AIDS Spending in Poor Countries $120 million $235 million $449
million $690 million
(not NIH research) $895 million (not NIH research)

U.S. AIDS Spending in Africa $55 million $109 m (USAID) +$25 m (est.
CDC) $145 m (USAID) +$75 m (est. CDC) $460 million (estimate) $597
million (estimate)

Estimated AIDS Needs from All Donors $7-10 billion $9
­12
billion
Estimated AIDS Needs from U.S. $2.5 billion $3.5
billion

U.S. Funding for all Disease Control $1 billion (USAID)
+ 350 m (est. other)
Estimated Needs for U.S. Funding for all Disease Control
$ 3 - 4 billion $7 - 8 billion

U.S. Contribution to Global Fund $200 $100 m $200m
Estimated Need for U.S. Global Fund Contribution $1 billion
$2 billion $3 billion

Paul Davis
[email protected]
Health GAP Coalition
ACT UP Philadelphia

+1.215.833.4102 mobile
+1.215.474.6886 tel.
+1.215.474.4793 fax