Testimony on the FY 2007 Budget Request for the President's Emergency Plan for AIDS Relief

Mr. Chairman and Members of the Subcommittee:

Thank you for this opportunity to discuss President Bush’s Fiscal Year 2007 budget request for his Emergency Plan for AIDS Relief, or PEPFAR. 

We have greatly appreciated the partnership between PEPFAR and the Foreign Operations Subcommittee over the years. We would like to thank all the members of the Subcommittee, and particularly you, Mr. Chairman, for your commitment to U.S. leadership in the fight against this tragic pandemic.

Thanks to the commitment of Congress and the American people, the U.S. Government is by far the largest contributor to the fight.  Based on UNAIDS estimates, in 2004 our government contributed more than all other governments combined.  With our overall contribution of over $3.2 billion in the current fiscal year, and the President’s over $4 billion request for Fiscal Year 2007 as we approach the promised level of $15 billion over 5 years, the U.S. will continue to lead the world in responding to HIV/AIDS.

The President’s request covers all bilateral HIV/AIDS programs supported by the U.S. in over 120 nations around the world, as well as research and our contributions to multilateral organizations such as the Global Fund.  In the brief time I have this morning, I would like to focus on the approximately $2.8 billion, of which about $2.7 billion is from Foreign Operations, for U.S. bilateral programs in the 15 focus countries of the Emergency Plan. This request includes an approximately $700 million increase over the current fiscal year for focus country bilateral programs.
 
The first two years of bilateral Emergency Plan programs, undertaken in partnership with host nations, produced dramatic results in the focus countries in the 20 months from its first appropriation through September 30, 2005. Let me take a moment to summarize these results.

In terms of prevention, the U.S. supported 'ABC' prevention interventions within national strategies for over 42 million people in Fiscal Year 2005. We supported prevention of mother to child transmission (PMTCT) services for over 3 million mothers over two years, resulting in the prevention of an estimated 47,100 HIV infections among children born to infected mothers.

PEPFAR supported life-extending antiretroviral treatment for approximately 401,000 people in Fiscal Year 2005 in the 15 focus countries, as well as 70,000 in other nations for a worldwide total of 471,000. Children were reported to be approximately 7 percent of those receiving treatment at U.S.-supported sites – a number that likely understates the reality, and one which is expected to rise as pediatric programs are scaled up in the coming years. In addition, highlighting the commitment of PEPFAR to meeting the needs of women, approximately 60 percent of those receiving treatment at these sites were women.

The Emergency Plan supported care for nearly 3 million orphans and vulnerable children and HIV-positive people in Fiscal Year 2005, 52 percent of whom were girls. Counseling and testing, a crucial gateway to prevention, treatment, and care, has been supported for over 9.4 million people over two years. Approximately 69 percent of those who received counseling and testing were women.

Undergirding all these accomplishments are partnerships with host nations to ensure that their responses can be sustained over the long term. The U.S. Government has supported capacity-building, training and re-training for nearly 850,000 service providers over two years, laying the foundations for continued success and sustainability. 

These results reflect the unprecedented speed and effectiveness with which funds have been utilized in bilateral programs. After the first 20 months of PEPFAR, over 94 percent of our funds were obligated and approximately 60 percent outlayed – a remarkable testament to the dedication of our U.S. Government personnel to saving as many lives as possible, as rapidly as possible.

Funding at the President’s requested level for the focus countries for Fiscal Year 2007 is essential if we are to meet the goals of the President and Congress:  support for treatment for 2 million, support for prevention of 7 million infections, support for care for 10 million.

Let me discuss treatment for a moment. In many places in the focus countries, our key constraint today is funding. An informal survey of U.S. Government teams in six focus countries in 2005 revealed that currently supported sites had capacity to serve 82,000 additional people with treatment, if resources had been available to do so.

For the coming year, across all 15 focus countries, we estimate that a $100 million reduction in Fiscal Year 2007 funding for prevention, treatment, and care -- including a $55 million reduction in treatment funding -- would lead to approximately 39,000 fewer individuals receiving treatment. Comparable effects on prevention and care would be expected.

Simply put, if the request for Fiscal Year 2007 focus country funds is reduced, the five-year treatment goals will be missed – and no increase in funding the following year would be able to undo this. This is because Fiscal Year 2007 is the critical year to build capacity for the even more massive treatment scale-up, from 1.3 million people to 2 million, planned for Fiscal Year 2008. The investment in the coming year is the only way that expansion will occur the following year.

In prevention and care also, funding constraints can greatly limit the ability of our partners to meet urgent needs. For example, our country teams have had to make very difficult choices among prevention programs – choices dictated in part by limitations in funding, as resources requested for focus country programs have been directed to other activities, such as support for the Global Fund.

The Global Fund remains an important part of the Emergency Plan strategy, and the U.S. Government remains by far its largest single source of contributions. Each country needs to find the right mix of bilateral and multilateral contributions to get the most immediate results from its investment. In light of the achievements, capacity, and efficiency of U.S. bilateral programs, the President’s request strikes the right balance for Fiscal Year 2007.

Mr. Chairman, I understand the difficult trade-offs this Subcommittee has to make in light of the wide range of international challenges our nation faces, and I thank you for your consideration of the President’s request. This Subcommittee can be proud that through the President’s Emergency Plan, the American people are partners with families, communities, and nations that are reclaiming their future.

Mr. Chairman, I ask that my full testimony be included in the record.  I would be happy to address your questions.