WASHINGTON, DC - January 28 - In this evening's State of the Union Address, President Bush is expected to highlight some of his signature initiatives on global poverty, such as the global AIDS program (PEPFAR) and the Millennium Challenge Account. In mid-February he plans to visit several African nations to see the results of these initiatives firsthand. Yet, despite real successes due to the President's leadership, he is now putting his legacy at risk.

• In the President's last budget to Congress, we expect him to undercut his own initiatives by proposing little or no funding increase for fiscal year 2009. In previous budgets he has proposed large increases, yet for the first time he will propose that the growth of these programs be scaled back dramatically.

• The flat-funding may even affect malaria programs. This week President Bush stated he would propose an "expansion" of his Presidential Malaria Initiative, but not if he shifts funds within the existing program and doesn't propose new money, as advocates fear.

The President's flat-funding of the AIDS initiative was first revealed in May 2007, but it was obscured by an ambiguous use of language. The President has proposed "doubling" spending to $30 billion on AIDS, but the reality is that his proposal would not double current spending at all. In fiscal year 2008, the US is spending $6 billion on AIDS, which multiplied over five years totals $30 billion. In order to be consistent with his five-year proposal, the President is expected to propose flat funding for fiscal year 2009. A real doubling of current funding would be $60 billion.

Tuberculosis (TB) is highly contagious, and the Department of Homeland Security has identified extremely drug-resistant TB as an "emerging threat to the homeland." Yet, the $30 billion proposal also flat-lines funding for tuberculosis, since the AIDS proposal covers the TB budget.

Should the US programs on global health really be stalled? Why would the President pull the rug out from under his signature initiatives during his last year in office? What impact will this have on US efforts to convince other nations, such as Japan and our European partners, to step up?

The Global AIDS Alliance believes that flat-funding AIDS and other programs is a very serious mistake. Congress must not allow the US to abdicate its responsibilities. As it prepares to reauthorize the next five years of the US response to the AIDS epidemic, Congress must also be steadfast in addressing Bush's legacy of ideologically driven approaches to HIV prevention.

US International Credibility Is On the Line

It is crucial that the US show it can be relied upon to keep its promises and work cooperatively with our allies to solve global crises. The US cannot afford to allow cynicism to grow regarding its seriousness on issues of concern to the developing world.

The US made an important promise last year, along with the rest of the G8—to ensure universal access to all HIV/AIDS services by 2010. The G8 nations also promised to support tripling the amount of resources allocated to the Global Fund to Fight AIDS, TB and Malaria.

President Bush has personally insisted that he backs the Global Fund, yet he is expected to propose a 64% reduction in the US contribution to the Fund for 2009.

Unless US support for global AIDS programs is greater than Bush's proposal of $30 billion, including sufficient resources for the Global Fund, it will be impossible for the US to hold up its end of the bargain on these crucial commitments. The US's ability to leverage strong support from other nations for the fight against AIDS will be severely undermined if the Bush plan goes forward.

The Need Is Still Great

Despite recently updated estimates of the epidemic, each day AIDS still kills about 6,000 people and infects another 7,000. Thanks to PEPFAR and other programs, 3.1 million people are now on AIDS treatment; however, this is out of a total of 12 million who urgently need treatment in order to survive. Unfortunately, the details of President Bush's proposal show a much lower US commitment on access to treatment.

Because of the continuing death toll, the number of orphans needing support is expected to reach 19 million by 2015. Less than 10% of children orphaned and made vulnerable by AIDS are receiving any type of support.

Prevention programs are also still falling far short. For example, HIV-positive pregnant women need medication to stop transmission of the HIV virus to their newborns, but only about one in 10 have access to the drugs. Access to comprehensive sex education, condoms, safe and voluntary male circumcision, and programs to empower women and girls, is still limited.

Much of the shortfall in access is due to lack of funding. To address the funding shortfall, a coalition of health advocates is calling for $59 billion in US spending over the next five years, includes $9 billion for tuberculosis and malaria programs. This funding would also address the severe shortage of health care workers, including pediatricians.

Increases in spending are needed in other areas to put the Millennium Development Goals within reach. The Global AIDS Alliance is calling for a dramatic expansion in the overall amount of funding available for poverty-focused aid, including for clean water, family planning, and child survival programs.

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