Shashank Bengali/MCT/Landov

With these cuts, they may die

Politics | In budget-cutting fervor, House Republicans slash the Bush era's successful global health initiatives-and Christian leaders are pushing back: "Make cuts . . . but not for the most vulnerable"

Issue: "Libyan exodus," March 26, 2011

Until 2006, when AIDS patients came to Karanda Mission Hospital in rural Zimbabwe, the medicine doctors had to offer was the gospel. Dan Stephens, the physician who runs the hospital, which is a three-hour drive north of Harare, the capital, said the staff didn't have the resources to test patients for the virus, much less treat them. Every day a patient in the 130-bed hospital would die.

"You had no hope. There was no treatment," Stephens said. "We could take care of your diarrhea, perhaps."

Today Karanda treats 3,000 HIV/AIDS patients a year, keeping them alive with antiretroviral (ARV) drugs. The hospital, open since 1961 and run by The Evangelical Alliance Mission, also provides treatment to pregnant mothers to prevent them from transferring the virus to their babies. "It's a whole new world now-a new vibrancy in the air," Stephens said.

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The national rate of AIDS infection in Zimbabwe has dropped dramatically in the last decade from 26 percent to 15 percent, thanks mainly to education about the disease and changes in sexual behavior, according to a study published in the journal PLoS Medicine. Karanda, for its part, counsels its patients about being faithful to one spouse as a way to prevent the spread of the disease.

Karanda's AIDS program, which took off five years ago, relies entirely on the Global Fund, an international fund for AIDS, malaria, and tuberculosis treatment. The United States is the chief contributor, providing about a third of funds to date.

President George W. Bush spearheaded the international effort to fight AIDS starting in 2002, designating millions for the newly created Global Fund and creating the President's Emergency Plan For AIDS Relief (PEPFAR), a companion U.S. program that has treated more than 3.2 million AIDS patients worldwide through local hospitals and nongovernmental organizations. But now Republicans are slashing those initiatives. The House budget for the rest of this fiscal year cuts the U.S. contribution to the Global Fund by 40 percent compared to last fiscal year's contribution, and slashes PEPFAR's budget by $363 million-or about 10 percent less than last year's budget.

Ambassador Eric Goosby, head of PEPFAR and the U.S. Global AIDS coordinator, laid out the stark result of the proposed cuts in an interview: "They're going to kill a lot of people, flat out."

PEPFAR officers estimate that 400,000 HIV/AIDS patients who were supposed to begin treatment will not be able to under the proposed cuts. And 100,000 fewer mothers will receive services to prevent transmission to their babies-which PEPFAR estimates means 20,000 more babies will be born with HIV.

The program has changed the course of the HIV/AIDS epidemic in seven short years, increasing the number of patients receiving ARVs from 50,000 before the program began to more than 3.2 million since. Drugs to pregnant mothers have prevented the transmission of the virus to 140,000 babies.

Congress will consider the cuts, which have Republican support, as it attempts to pass a spending bill covering the rest of this fiscal year. Even if the cuts Republicans proposed for the remaining months of this fiscal year do not pass, they reveal the vulnerability of global AIDS funding in the budget for fiscal year 2012. Before he took office, President Barack Obama publicly promised Bush that he would continue funding the global AIDS effort, and Obama's proposed 2012 budget increases the program's funding. Christian groups-including conservative evangelicals-are lobbying Republicans to address the nation's debt crisis without slashing an effective program that is keeping millions alive. "If we didn't have outside resources, we would die," Stephens said.

The U.S. Conference of Catholic Bishops and Catholic Relief Services (one of the top recipients of PEPFAR funds in Africa) penned a letter to Congress opposing the cuts to the global health programs, noting that while the House cut the overall budget by 2.6 percent, international programs for the poor bore 26 percent of cuts: "Shared sacrifice is one thing; it is another to make disproportionate cuts in programs that serve the most vulnerable," they wrote. "Cuts at the level being considered will result in the loss of innocent lives."

PEPFAR has a wide array of supporters, from the Catholic bishops to evangelicals to liberal gay activists. Ray Martin of Christian Connections for International Health said his organization is forming a network of international Christian health organizations to fight to preserve the programs. Shane Claiborne of the Simple Way, Ron Sider of Evangelicals for Social Action, Richard Mouw, president of Fuller Theological Seminary, and others signed onto "A Christian Proposal on the American Debt Crisis," which supports cuts in federal spending but argues the poor should not bear dis­proportionate cuts, as they do in the current spending bill.


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