You cannot change policy with abstract, cool-headed intellectual debate alone, as Michael Walzer showed in Politics and Passion. Why should people concerned about AIDS just be quiet and cooperate? Do we also expect people working on other issues like Darfur or torture or global warming to just be quiet? I don't think so, not when there are real issues at stake and passion is essential to progress.

It is simply not true that the $63 billion pledge is great for HIV/AIDS patients. What really matters is not a pledge for distant spending but what is in the year-by-year budget proposal. And that shows a near flatline proposal from the President for FY 09, FY 10 and FY 11 for AIDS and TB. It is not inevitable that this happen again for FY 12 -- thus the fight.

While there is a public fight, at the same time there is also an intense and productive dialogue with the Administration about the issues, including how to get more out of the money that is already available. Contrary to what Dr. Emanuel says, AIDS advocates have already been putting forward many creative ideas about how to do that. There is a lot more cooperation and learning from each other going on than is obvious from the news coverage.

Actually, the public fight has not prevented wide coverage of key developments -- that it is possible to block infection with a vaginal gel (front page, W Post) and that is possible to actually save money and prevent infections by providing early and easily accessible treatment.

Actually there IS an emerging global consensus on how to fight AIDS, and it is laid out in the latest UNAIDS strategy. This is not a fight just for the sake of fighting -- calm, reasonable, behind the scenes lobbying for funding can only accomplish so much...as we have seen again and again.

Dear Ms. Dickinson,

The current struggle around AIDS funding is not a case of both sides being right. The White House has flat funded HIV/AIDS globally. In fact, PEPFAR's slight increase of 1-2% will largely get eaten up by the inflation rates in developing countries, which hover around 4-5%. This means that current programs cannot expand and there are some reports that some clinics are turning people away as there is little money to enroll new patients through PEPFAR.

Dr. Emanuel made a stark case in November 2009 in the Journal of the American Medical Association--he said new spending on global health should go to cheaper interventions for maternal and child health rather than any substantial new investments in AIDS care. The Obama global health policy is largely based on this Malthusian notion, which pits disease against disease, in a race to the bottom, for the lowest common denominator in global health.

AIDS activists have no problem with money for maternal and child health, for health systems development--we've been broad-minded advocates since the beginning of the epidemic. AIDS is a disease of primary care, so we need strong health systems and AIDS disproportionately affects women--new investments in these areas are long overdue. But if you look at the new money that the Obama Administration is putting on the table, it's not anywhere near the need for MCH or health systems strengthening, even in PEPFAR countries.

AIDS activists were "too" successful for political leaders like President Obama, who despite his personal sympathy for the cause, sees no political gain in large spending on health and development overseas. It's not a priority for the White House and the real numbers sent up to the Hill for AIDS, for MCH, for all of health and development show it. By going after AIDS, trying to make our demands seem unreasonable, the White House is trying to neutralize the strongest advocates for global health in a generation. This way, they can pay lip service to global health, but won't have their feet held to the fire in quite the same manner and certainly won't have to make big investments in any area of global health in the near term.

A truly comprehensive global health initiative--for AIDS, for TB, for neglected diseases, for health systems, for MCH, etc-- would be music to my ears--and would make the current debates, the "funding wars", moot. The conventional wisdom is we can't do it, we can't afford it. But there is a lot of money sloshing around even in this recession--it is lavishly awarded to banks and failed European states in the trillions. A small fraction of that could go a long way in health and development--in fact, AIDS activists recommended a comprehensive global health plan back in 2009 at a cost of $15 billion by 2012--www.theglobalhealthinitiative.org.

People protested in Vienna, Archibishop Tutu wrote an op-ed in the NY Times because the truth is that the Obama Administration has put AIDS, and the rest of global health on the back-burner. No amount of spin from Dr. Emanuel or Gayle Smith on the White House's blog today will change that. We all recognize that the President has big things on his mind, from two wars, to health care and financial reform package to implement, an oil spill for starters. We simply think global health, not just AIDS, is equivalent in importance to these things, since millions and millions of lives are at stake.

Finally, the White House has said recently in relation to their commitment to HIV/AIDS, that "it's not about the money"--well, let me give you a case much closer to home. 2000+ people are on waiting lists for AIDS drugs in the USA--yes, here in the richest country on earth. About $150-160M would save these people's lives--yet the White House decided $25M was enough of a symbolic gesture for these folks. It's not about the money--yes, it's about these people's lives. Can you honestly tell me the White House can't find $150-160M to save these people?

This is what is happening--it's not about agreeing to disagree.

The White House "feels our pain" but in the end isn't prepared to do much more than that.

The US cannot spend its entire GDP on AIDS. It is not the global ATM machine. I have no empathy for anyone volunteering American tax money for their particular philanthropical cause when they should be reaching into their own pockets.

That Obama is offering any money is mind-boggling. He is president of the US and needs to take care of his own first, especially when millions of Americans have difficulty affording medical care for themselves and the country is dealing with a deep debt crisis.

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