The Global Fund and PEPFAR in U.S. International AIDS Policy

Publication Date: November 2005

Publisher: Library of Congress. Congressional Research Service

Author(s):

Research Area: International relations

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Abstract:

The United States is responding to the international AIDS pandemic through the President's Emergency Plan for AIDS Relief (PEPFAR), which includes bilateral programs and contributions to the multilateral Global Fund for AIDS, Tuberculosis, and Malaria. PEPFAR overall appears on target to meet the Administration's five-year, $15 billion spending plan, although competing budget priorities could affect its prospects. By contrast, the Global Fund, which relies on multiple donors, is reporting a funding gap that may prevent it from awarding new grants to fight the pandemic. The Fund estimates that it needs $3.3 billion in 2006 and 2007 to cover the renewal of its existing grants, in addition to $3.7 billion in order to fund two new Rounds of grant-making. At a September 2005 Global Fund pledging conference in London, donors offered a total of $3.7 billion for the two years, and unless additional pledges are made, the Fund will be able to do little more than fund existing grants.

The United States, at the London meeting, pledged a total $600 million for 2006 and 2007, although Andrew Tobias, the U.S. Global AIDS Coordinator, suggested that Congress might provide a larger amount. Congress has consistently appropriated more than requested for the Fund. Some believe that the Administration increased its FY2006 request for the Fund to $300 million, from $200 million sought in FY2003-FY2005, in recognition of the support the Fund enjoys in Congress.

Representatives of the Global Fund and PEPFAR maintain that their programs are complementary, and that they are partners rather than competitors. The United States is the largest contributor to the Global Fund through PEPFAR. Some worry, however, that there are strains between U.S. officials and the Global Fund, pointing to the tendency of the Administration to request less for the Fund than Congress has been willing to provide. Global Fund representatives attended a major PEPFAR planning session in May 2005, and this is seen by many as one indicator among others that any past strains between the two programs are easing.

Advocates for the Global Fund seek a major increase in the U.S. contribution, arguing that it would affirm U.S. leadership in the struggle against AIDS and persuade other donors to increase their support. They believe that the Global Fund has several unique advantages, including its multilateral character, its contribution to capacity building, and its operations in countries other than the 15 PEPFAR focus countries. Supporters of U.S. bilateral programs note that they too build capacity and operate beyond the focus countries, while bringing the capacities of highly experienced U.S. agencies to bear in fighting the pandemic. Through PEPFAR, some argue, the United States is already doing more than its fair share in fighting AIDS, and any large increase for the Global Fund should come from other donor countries. U.S. officials and others are also encouraging contributions from private sector sources. Such contributions have been limited to date, apart from $150 million contributed by the Bill and Melinda Gates Foundation. This report will not be updated. For further information, see CRS Report RS21181, HIV/AIDS International Programs: Appropriations FY2003-FY2006 and CRS Report RL31712, The Global Fund to Fight AIDS, Tuberculosis, and Malaria: Background and Current Issues.