Forward

At the dawn of the new millennium, there are few threats more dangerous to mankind than the global HIV/AIDS pandemic. Infecting 40 million people and already accounting for 25 million deaths, it could well become the worst health crisis in modern history. While centered today in sub-Saharan Africa, it is spreading rapidly in India, China, Central Asia, and Russia.

In January 2003 President George W. Bush announced a $15 billion President’s Emergency Plan for AIDS Relief (PEPFAR), intended to achieve a series of five-year goals: preventing 7 million new infections, getting 2 million infected people on treatment, and caring for 10 million people with HIV/AIDS.

This report recognizes that PEPFAR is a historic and laudable initiative. But the administration’s plan is too near-term in orientation and too narrow in scope to achieve its long-term objectives. This report recommends that the United States adopt a longer-term and broader-based strategy, addressing, in particular, the basic health systems that developing countries need and the critical issues that go beyond health delivery. While this strategy will require more resources, it will be more likely to enable the United States to reach its five-year goals for PEPFAR, and it will enhance the ability of the United States to effect long-term, sustainable progress against this and other diseases.

The report, a Council Special Report and Milbank Memorial Fund Report, is the product of a joint project by the Council on Foreign Relations and the Milbank Memorial Fund, in conjunction with the Open Society Institute. The project convened meetings with specialists and representatives of more than 30 government and private organizations working in this field, with the U.S. Global AIDS Coordinator and his staff, and with numerous individual researchers.

The Council and the Fund have each worked for many years to bring the best available information and ideas to bear on the development and implementation of policy in their respective fields—the Council in foreign policy and national security matters, the Fund in health care and population health. This is our second joint project. In 2001 the Council and the Fund published the report, Why Health Is Important to U.S. Foreign Policy. Daniel M. Fox, President of the Fund, proposed that the two organizations collaborate again on the HIV/AIDS crisis and invited the Open Society Institute to collaborate in recognition of its path-breaking work in this field.

Princeton N. Lyman, Ralph Bunche Senior Fellow and Director of Africa Policy Studies at the Council on Foreign Relations, and Daniel M. Fox directed the project. Greg Behrman was the coordinator of the project and is the principal drafter of the report.

The Council and the Fund are grateful to many colleagues who contributed to this report. They are listed in the Acknowledgments.

Princeton N. Lyman
Director of Africa Policy Studies
Council on Foreign Relations

Daniel M. Fox
President
Milbank Memorial Fund