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Foreign Aid Priorities – Is Doubling HIV/AIDS Funding the Way to Go?
Daniel Halperin, a former USAID HIV prevention advisor for Africa, poses this question in a recent NY Times op-ed. While noting that as many as 33 million people worldwide are still living with HIV, and that the pandemic continues to spread, Halperin poses the question of whether $15 or $30 billion (as proposed by the President) or even $50 billion over five years (as pledged by some presidential candidates) for HIV/AIDS makes sense in light of the other urgent public health needs in the developing world. He notes that last year the US spent almost $3 billion on AIDS programs in Africa, while investing only about $30 million in safe-water projects – a nearly 100-1 imbalance. Yet, inadequate access to safe water results in devastating diarrheal diseases and many more deaths around the world than AIDS. Millions of African children and adults every year die of malnutrition, pneumonia and other largely preventable, if not headline-grabbing, conditions.
Halperin highlights the importance, for the US as the largest donor, to re-examine the epidemiological and moral foundations of its global health priorities. “With 10 million children and half million mothers in developing countries dying annually of largely preventable conditions, should we multiply AIDS spending while giving only a pittance for initiatives life safe-water projects?”
This is an appropriate and important question. However, a more fundamental question might be what recipient countries think of our priorities. Although it may not be intended, the implication is that African or Asian governments’ views regarding how aid dollars can be most effectively spent are of secondary importance to our own. As long as this mentality prevails, we can expect foreign aid funding priorities to be determined by domestic US interests and agendas -- not the on-the-ground realities and needs – and to be less than fully embraced by the people we’re supposed to be assisting. It is likely that, given the opportunity, recipient countries would opt for a significantly different ordering of priorities. This is one of the strengths of the Millennium Challenge compacts – they reflect recipient countries’ views of what they need, which may not always comport with what we think they need. It’s time the broader US foreign aid program took a similar approach and started paying more attention to their priorities than ours.
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