MARY LOUISE KELLY, host:
President Obama has made some major changes in the past year to this country's Afghanistan strategy, promising to triple the number of troops there and to focus on counterinsurgency techniques.
But when it comes to global AIDS policy, the president has pretty much stuck to the blueprint laid out by the Bush administration. And for some people dedicated to fighting AIDS, that's a concern.
NPR's Brenda Wilson reports.
BRENDA WILSON: Nearly $14 billion were spent on the global AIDS epidemic in 2009 with the U.S. contributing about half of that money. That's far more than the hundreds of millions of dollars that were spent a decade ago. It means that millions of people in developing countries now get anti-AIDS drugs.
But that's made U.S. Global AIDS Ambassador Eric Goosby's job harder.
Ambassador ERIC GOOSBY (U.S. Global AIDS): We are constantly increasing the number of individuals that are alive and continuing to use services. And it is a growing crescendo kind of economic burden that the United States and the countries are learning how to accommodate.
WILSON: That strategy may have worked well getting millions of people into treatment, Goosby says. But it's neither efficient nor sustainable to continue to deal with AIDS as if it is an emergency.
Amb. GOOSBY: One that is completely dependent on offshore resources and not embedded in the public system of the country runs the risk of being ephemeral and dependent on how steady and reliable those resources remain.
WILSON: And the recent global recession has threatened both the steadiness and reliability of that kind of funding. Instead of relying on one program, such as the President's Emergency Plan for AIDS Relief or PEPFAR, Goosby says the U.S. has a new five-year strategy that would help low and middle income countries build their own health care systems that incorporate international health programs.
Amb. GOOSBY: Taking the PEPFAR, the TB, the malaria, the vaccine, the maternal to child health, family planning, reproductive health, platforms, pull them together to actually really create a central package of primary care services.
WILSON: Talk like this worries AIDS advocates who see the administration broadening the global health agenda without putting much more money in. As it now stands, only half of the people who need drugs are getting them.
Christine Lubinski of the Infectious Diseases Society of America thinks the president chose the right person for the job but put him in an impossible position.
Ms. CHRISTINE LUBINSKI (Vice President for Global Health, Infectious Diseases Society of America): I happen to feel they made a very good choice. A man who's been an amazing advocate and provider of HIV treatment, and now may be faced with telling all of these countries they need to do more with less. At the same time, you know, tens of thousands of very sick people are knocking on the door asking for treatment.
WILSON: That's where we are now more than 25 years into the epidemic with no end in sight. In 2031, the epidemic will be 50.
Robert Hecht, a development expert with AIDS 2031, recently did some projections on how to spend AIDS money to get the best results.
Mr. ROBERT HECHT (Development Expert, AIDS 2031): Smart prevention today, like male circumcision or preventing the transmission from infected mothers to their babies, reaching discriminated, stigmatized groups like men having sex with men, or injecting drug users in certain countries, if the money is concentrated in those kinds of areas, we can both slow down the number of new infections and can lower the costs of treatment in the future.
WILSON: In fact, targeting prevention is a key part of the administration's global AIDS strategy, one that it says developing countries will need to buy into if they ever want to get the epidemic and its cost under control.
Brenda Wilson, NPR News.