Other U.S. Agencies Involved in Developing Countries

Department of Defense (DOD)
Other Agencies
Table 7: US International AIDS Funding by Contractor/Grantee & by Program Area
Table 8: US Federal Agencies, with Intramural & Inter-Agency International AIDS Programs by Program Area, FY 1998
Table 9a: US 1998 AIDS Funding Targeted to Africa by Agency Projects
Table 9b: US 1998 AIDS Projects in Africa by Program Type
Table 9c: US 1998 AIDS Funds Targeted to Asia by Agency
Table 9d: US 1998 AIDS Projects by Program Area
Table 9e: US 1998 AIDS Funding Targeted to Latin American/Caribbean & Eurasia by Agency
Table 9f: US 1998 AIDS Projects in Latin America/Caribbean & Eurasia by Program Area

We did not include the DOD's international HIV/AIDS program in our analysis because DOD refused to provide detailed program information. Nor did we include activities of other U.S. agencies described in the 1999 Department of State report on the international U.S. effort (see below), as these were all rather small efforts dwarfed by the "big three." Here we provide a summary of what little information we were able to obtain about the DOD program and about other U.S. activities.

Department of Defense (DOD)

The DOD HIV program is part of the tradition of military medicine that focuses on possible health threats to U.S. military personnel abroad. Its primary focus is mitigating possible infectious threats to U.S. troops and developing medical interventions for combat situations. The Army's Medical Research and Material Command operates the U.S. Army Research Institute for Infectious Diseases (USAMRIID) and maintains research sites in Kenya and Thailand. The medical and research command also operates the Walter Reed Army Research Institute in Bethesda, Maryland. The Naval Medical Research Center operates an infectious diseases directorate as well as Naval Medical Research Units (NAMRUs) in Indonesia, Peru, and Brazil.

The U.S. military published a report on its HIV research program in 1998, which we used to assess the nature and location of HIV-related military research activities. DOD web sites were also examined. DOD sources stated that they were "not at liberty to disclose" budgetary information regarding the department's international activities related to HIV/AIDS. Since they did not provide us with information for this report, the information here about its program is the least textured, and we did not include DOD figures in our overall totals for the year 1998. We could not determine the overall administrative structure of the DOD HIV research program, nor exactly how and where the funds were allocated.

The DOD HIV/AIDS programs include epidemiology, surveillance, a small amount of treatment research, and a substantial preclinical and clinical HIV vaccine discovery and development program. We did not obtain enough information to summarize total DOD HIV/AIDS spending, let alone its international components broken down by program area or country of activity.

After NIH, DOD supports the other major U.S.-funded international HIV vaccine program. Army research units in Thailand, Kenya, and Brazil focus on vaccine development.

Another component of the DOD HIV/AIDS program is the Defense Intelligence Agency's Armed Forces Medical Intelligence Center (AFMIC), which "will continue to assess systematically worldwide HIV/AIDS incidence and prevalence [and] forecast the impact of HIV/AIDS . . . on US national security interests and deployed forces, . . . [and] on foreign military force readiness, military and civilian healthcare infrastructures and transnational health trends" (Department of State 1999).

We obtained information from the DOD Technical Information System (www.dtic.mil), whose archives yielded U.S. Army Research, Defense, Test & Evaluation (RDT&E) budget justifications which were prepared in February 1999 and 2000. These reports reveal that the military plans significant reductions in HIV research expenditures over the coming years. The military's HIV- related budgets varied depending upon the report examined, with decreases apparently planned from 1998 through 2005. In 1998, military HIV research expenditures were about $20.4 million.

In 1998, the military's main efforts included developing experimental models of disease, preparation of new vaccine candidates, improved diagnosis of disease, and risk assessment. The military report went on to list $18,694,000 of the FY 1998 money as having been spent on gp140 and nef-deleted live attenuated SIV vaccines in macaques, DNA and gp160 SHIV vaccines, as well as a phase I study of a DNA vaccine, epidemiology studies in Thailand, and HIV surveillance and risk assessment activities in North Africa, the Middle East, Eastern Europe, and South Asia. Administrative overhead at the Walter Reed Army Institute of Research (WRAIR) was $1.72 million for oversight of these activities, for a total of $20.414 million.

Strangely, the DOD's 1999 budget justification proposed spending $14.548 million on HIV/AIDS research in FY 1999, while the 2000 budget justification proposed spending only $3.34 million, and only described activities related to phase II clinical trials of gp120 and gp160 vaccines. In any case, cumulative Army HIV/AIDS research spending from 1999 to 2005 was listed as $84 million in the 1999 budget and only $17 million in 2000. What happened to the missing money?

Clearly a more accurate, comprehensive, and detailed analysis of the U.S. Department of Defense's role in HIV-related activities, both domestic and international, is needed, and DOD needs to make substantially more information about these activities accessible to the public.

Other Agencies

The Office of National AIDS Policy (ONAP), reporting to the president, is supposed to coordinate all federal HIV/AIDS activities. ONAP carries out no programs of its own, other than supporting the President's Council on HIV/AIDS (PACHA), which has an international subcommittee. The ONAP director's press release on the president's FY 2001 budget request cited the administration's proposed $100 million increase in support for international AIDS activities to be carried out by CDC, DOD, the Department of Labor, and USAID. (Curiously, NIH was omitted from this list.) However, ONAP did not break out global HIV/AIDS funding for FY 2001 or any previous year.

The Department of State's 1999 U.S. International Response to HIV/AIDS report covered all federal agencies and departments, though often with little detail. For example, its own Bureau of Oceans & International Environmental & Scientific Affairs/Emerging Infectious Diseases & HIV/AIDS Program "works with USAID and other federal agencies to develop the bilateral and multilateral partnerships to address the unique implications of HIV/AIDS and other infectious diseases." The Bureau of Population, Refugees & Migration (PRM) "coordinates efforts ... to implement a more comprehensive international population policy." The Bureau of Democracy, Human Rights & Labor (DRL) "oversees initiatives and policies to promote and strengthen civil society and respect for human and worker rights." Finally, "The President's Interagency Council on Women, which is chaired by the Secretary of State, is charged with coordinating the implementation of the Platform for Action adopted at the [1995 Beijing] UN Fourth Conference on Women, [which] recommends action to ... undertake gender-sensitive initiatives that address STDs, HIV/AIDS, and sexual and reproductive health issues." The Department of State report includes no figure for overall state spending on HIV/AIDS, nor for international HIV/AIDS spending.

The U.S. Information Agency (USIA) arranged speaking tours for U.S. AIDS experts, broadcast coverage of World AIDS Day in 52 languages, and published AIDS-related policy statements and analysis on the USIA international homepage. According to the Department of State, "USIA exchanges under the Fulbright, International Visitor, and U.S. Speaker programs budgeted $655,200 in FY 1998 on HIV/AIDS programs. This figure has been relatively constant since 1995."

U.S. Peace Corps* HIV/AIDS activities include education of Peace Corps employees and volunteers, and prevention efforts conducted by Peace Corps volunteers in host countries. Except for support received from USAID (described above), the Peace Corps does not earmark specific funding for HIV/AIDS activities. In June 2000 they announced a $500,000 gift from the Bill & Melinda Gates Foundation to bolster their HIV/AIDS training and community outreach efforts.

The Department of Commerce includes the U.S. Patent & Trademark Office (USPTO), which "offers accelerated processing of applications for inventions related to HIV/AIDS." In addition, the USPTO provides a searchable database containing the full text and images of all patents related to AIDS research, including about 3,000 U.S., 800 Japanese, and 700 European patent documents. The International Programs Center (IPC) of the Bureau of the Census* "compiles, evaluates, and analyzes selected health and related data for all countries overseas" and "with funding from USAID through an interagency agreement, the Health Studies Branch maintains and updates the HIV/AIDS Surveillance Data Base, which is a compilation of information on HIV prevalence and incidence from all available studies from Africa, Asia, Latin America, and some select countries in Europe." The IPC is a UNAIDS Collaborating Centre. The Office of the U.S. Trade Representative is also affiliated with the Department of Commerce.

The Department of Labor is slated to receive $10 million in "new" global HIV/AIDS funds in the president's FY 2001 budget request; however, the State Department's 1999 report does not mention any international HIV/AIDS programs carried out by this department.

* These programs are included in this analysis as USAID interagency contractors.

Table 7: US International AIDS Funding by Contractor/Grantee & by Program Area

This three-page table describes all US government contractors and grantees involved in the international HIV program, listed by size of total international budget.

Table 8: US Federal Agencies, with Intramural & Inter-Agency International AIDS Programs
by Program Area, FY 1998*

Table 9: Regional & Country Summaries
The following tables itemize funds targeted to individual countries and regions by program area and describe the number of HIV projects in each program area. For limitations of these data, see the section Materials and Methods.

Table 9a: US 1998 AIDS Funding Targeted to Africa by Agency Projects

Table 9b: US 1998 AIDS Projects in Africa by Program Type

Table 9c: US 1998 AIDS Funds Targeted to Asia by Agency

Table 9d: US 1998 AIDS Projects in Asia by Program Area

Table 9e: U.S. 1988 AIDS Funding Targeted to Latin American/Caribbean & Eurasia by Agency

Table 9f: US 1998 AIDS Projects in Latin America/Caribbean & Eurasia by Program Area