Dead on arrival. This is how President Donald Trump's malicious fiscal year 2018 budget has been described in every corner and cranny of Washington, D.C., since its release last week.
Members of Congress have largely condemned Trump's spending package to the budgetary dustbin. And that's across the board, whether it's senior conservative senators like John McCain, R-Ariz., and John Cornyn, R-Texas; moderate, purple state senators including Joe Manchin, D-W.Va., and Jon Tester, D-Mont.; or progressives like Representatives Pramila Jayapal, D.Wash., and Rosa DeLauro, D-Conn.
At first blush, these widespread denunciations of the Trump budget might give much-needed reassurance to global health activists who were appalled and outraged at the $4.6 billion in cuts to humanitarian assistance and global health spending, of which a staggering $1.08 billion was slashed from global HIV/AIDS programs.
But it's cold comfort for advocates who know that the real question is not if the funding cuts will come, but how severe cuts will be.
The Positive Legacy of PEPFAR
Let's be clear. Any Fiscal Year 2018 budget that Congress manages to pass will not include $1.08 billion in global HIV/AIDS funding cuts.
PEPFAR is one of the few positive legacies of former President George W. Bush's eight years in office. It's an increasingly rare example of productive inter-party cooperation in an era dominated by hyper-partisan bickering. And, as The New York Times reported after the budget's release, the $1.08 billion in global HIV/AIDS funding cuts would lead to the deaths of more than a million people -- a situation that would place responsibility for a massive human tragedy solely at the feet of those who supported it.
However, these hypothetical cuts are merely a starting point. It's imperative to know that there are other ways for Republicans in Congress to take out a large a chunk of these programs, without receiving the blowback for dismantling one of the most successful global aid programs in American history.
Budget negotiations in Washington are often characterized by a bizarre sort of calculus. Senators and representatives assess the leverage that they and their parties possess, and divvy up political capital in order to achieve the outcomes they want. While there are many members of Congress who hold strong views on proposed cuts to global HIV/AIDS funding in the Trump budget, they all enter the appropriations process knowing they won't be able to get everything they want and that certain portions of the budget may be easier to impact than others.
For instance, imagine you are a Democratic member of Congress who is looking to protect global HIV funding. You would assess whether you're more likely to find success by lobbying Republican colleagues to restore the $470 million in proposed bilateral PEPFAR funding cuts from the State Department, or by working to oppose the halving of the Centers for Disease Control's global HIV/AIDS budget.
On the flip side, Republicans in Congress who agree with many of the cuts in the President's budget -- even if they understand the need for global HIV funding -- are likely looking at whether they'll stump hard for the elimination of all $330 million in global HIV/AIDS program funding at the U.S. Agency for International Development, or hold fast to Trump's pledge to cut U.S. aid to the Global Fund by 17%.
Don't Fall Prey to Lowered Expectations: Rigorously Oppose All Cuts
But global HIV advocates do not have the luxury of picking and choosing which programs we fight for and which ones we let wither away.
Any proposed FY18 budget that contains cuts to any global HIV/AIDS program must be rigorously opposed and any passed FY18 budget that contains significant cuts to global HIV/AIDS programs must be considered a failure. We must not allow ourselves to fall prey to the lure of lowered expectations in which the Trump administration so frequently traffics.
Just because the President releases an inhumane budgetary wish list that aims to cut $1.08 billion from global HIV/AIDS funding does not mean that a $300 million cut is acceptable. Even the elimination of a comparatively small line item in the FY18 budget -- like the $28.7 million in funding for the International HIV/AIDS Vaccine Initiative -- must be vehemently opposed. Who's to know if the breakthrough that leads to a cure for HIV waits for us in that funding?
Every last bit of funding is more important than ever.
Remember, roughly $6 billion in current global HIV/AIDS funding is now at risk of being withheld after President Trump's reinstatement and expansion of the Global Gag Rule that prohibits the federal government from providing global health assistance to foreign nongovernmental organizations that speak up for laws permitting abortion.
It is up to us to remind members of Congress from both parties of the necessity and importance of providing robust support for combatting HIV/AIDS across the globe. Let them know that a vote for any of the draconian cuts in the Trump budget will be reflected against their favor at the ballot box.
Congress is out of session this week, which means that senators and representatives are back home. It is imperative that we meet face to face with our members of Congress at town halls, at their offices, or at local public events and make our voices heard.
If global HIV/AIDS funding isn't on our senators' or representative's radar, we must put it there. And if our senators or representatives think they don't have the political capital necessary to stop these cuts to global HIV/AIDS funding, we need to provide them with it ourselves. The Trump budget has the potential to undo 15 years of remarkable progress in fighting the HIV/AIDS epidemic across the globe and it is up to all of us to make sure that those gains are maintained and not squandered.