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Proposed cuts to U.S. bilateral AIDS funding threaten those most at risk for HIV, group says

OAKLAND, Calif. -- Officials with the Global Forum on MSM & HIV (MSMGF) are deeply concerned that President Barack Obama’s 2013 budget proposal cuts funding to the President’s Emergency Plan for AIDS Relief (PEFPAR) by more than $500 million.

The budget risks missing a critical opportunity to turn the tide of the epidemic, eroding vital support for U.S.-led global AIDS programs worldwide when unprecedented gains are within reach, the officials said.

In contrast to the cuts to PEPFAR, the proposed budget also includes an important $350 million increase to the Global Fund to Fight AIDS, TB and malaria.

Last fall, a UNAIDS-endorsed financial framework published in The Lancet showed that it is possible to achieve universal access and avert 12.2 million new HIV infections by 2020 – provided we dramatically scale-up funding efforts now. By funding a robust response up front, conservative estimates show that nearly 90% of expenditures can be recovered by 2020 through savings in treatment costs avoided.

As the framework notes, this kind of success can only be achieved with targeted investments for key affected populations, including men who have sex with men (MSM).

Last year, PEPFAR issued its first-ever technical guidance on HIV prevention for MSM, laying out a roadmap for scaling up the response among this hard-hit group. However, no specific funding has been set aside for sustained implementation of MSM programs in PEPFAR countries.

With the proposed 10.8% reduction in funding, PEPFAR’s ability to create new funding streams for key populations may be restricted just when they are needed most.

“Since the epidemic began over thirty years ago, advocates have been fighting for equitable funding and programs focused on those most at risk, including gay men,” said Dr. George Ayala, MSMGF executive officer.

“In the past few years, we have finally taken significant steps toward a more strategic, targeted HIV response that prioritizes populations most impacted by HIV. However, decades of experience have taught us that when budgets get tight, politically sensitive communities are the first to take the hit – gay men and other MSM, people who inject drugs, sex workers and transgender people. These are precisely the communities shouldering a disproportionately heavy burden of HIV.”

Last fall, the Global Fund cancelled its upcoming grant cycle due to the failure of donor countries to follow through on pledged donations. If approved by Congress, the 2013 budget allocation to the Global Fund would fulfill a $4 billion, three-year U.S. commitment to this vital funding mechanism, sounding a clarion call to other donor nations to step up and follow through on their commitments as well.

The Global Fund’s dedicated strategy on issues of sexual orientation and gender identity, coupled with a funding pool specifically earmarked for most-at-risk populations, have made it one of the most effective mechanisms to date for implementing HIV programs for those who need them most.

“Make no mistake,” Ayala said, “failing to fully fund the global response will take a grave toll on the world’s most vulnerable groups, creating a cascading effect that threatens to reverse crucial gains made in our work to end AIDS.”