“The persistent shortchanging of PEPFAR, the President’s Emergency Plan for AIDS Relief, is one of the more significant and perplexing trends in America’s global health policy,” Chris Collins, vice president and director of public policy at amfAR: The Foundation for AIDS Research, writes in the Huffington Post’s “The Big Push” blog. “Funding for PEPFAR … has been falling consistently from its peak in fiscal year 2010,” he notes. “This downward funding spiral might make sense if there was a consensus that tackling AIDS has become less important, or if PEPFAR was not producing results. But the opposite is true,” he continues, noting a recent Institute of Medicine evaluation of PEPFAR “concluded that the program has been ‘globally transformative’ and has ‘had major positive effects on the health and well-being of individual beneficiaries, on institutions and systems in partner countries, and the overall global response to AIDS.'” He also notes an announcement by former Secretary of State Hillary Clinton in November 2011 that “achieving an AIDS-free generation was a ‘policy priority’ for the U.S. government” and the release of a PEPFAR Blueprint in November 2012 “lauding the program’s accomplishments and affirming the need to ‘rapidly scale-up core … interventions.'”

“Why the mismatch between results, rhetoric, and financing?” Collins asks and speculates about an “administration decision to gradually de-emphasize bilateral AIDS investments in favor of multilateral institutions and multiyear commitments to these institutions,” such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. “It is not a matter of choosing between multilateral and bilateral approaches, but of marshaling sufficient resources to end AIDS,” he states, concluding, “Congress and the president should not set the AIDS budget based on short-term expediency. Instead they should recognize the longer game: defeating a major infectious disease, and securing this generation’s legacy as beginning the end of AIDS. To achieve that goal, both the Global Fund and PEPFAR need appropriate funding” (4/18).