FCAA’s Spring Convening Helps HIV Funders Navigate New Terrain

On the heels of a leaked draft of President Trump’s national budget — showing potentially devastating cuts to U.S. foreign assistance — FCAA held its Spring Convening – Mission Impossible: Retooling for a Changing Environment. Two expert panels provided the latest possible look at priorities of the new Administration, and then helped brainstorm how, as a sector, we can begin to reframe our narrative to protect critical HIV funding and policy.  Not surprisingly, the budget cuts set the tone for the day.

Because there was so much rich information shared at this convening, we are will be releasing two separate blog posts summarizing the contents of the day. In the coming days, we will provide details on the second of the day’s discussions.

When reflecting back on the meeting as a whole, three consistent themes emerged:

Advocacy. To provide some funding context for the day’s discussions, FCAA released our new infographic — on funding for advocacy and human rights — at this convening. While there was a 35% increase, to $123 million, in philanthropic funding for advocacy from 2014 to 2015, that is not lot of money to fuel the amount of work that must be done. Further, the large majority of those resources came from a small number of funders and only 18% of advocacy grants went to general operating grants. The pool of funders must be expanded and the resources increased if we are to be successful. It is clear that advocacy has never been more important; that it is the strongest lever to address the challenges we now find ourselves facing. As this data spotlight shows, this important intervention is not adequately funded.

Messaging. The composition of the new Administration provides our community with a new and likely less informed audience; therefore, we will need to be creative and nimble as we reframe our messages to resonate. We must educate decision makers as to why continued health and foreign investment is critical. At the same time, we can’t stop advocating for what’s important nor lose what we’ve gained over the past several decades. Therefore, we need to find a balance between staying true to our core values as a movement, and gaining an entry point with the new Administration.

Partnership. There was clearly a sense of unity among the organizations in the room. But there was an equally important call to collaborate not just with likely allies, but also with those who might be more unlikely, such as corporations, faith-based communities, the military, and young people.  And this must be navigated carefully – look for opportunities to find common ground where we have it, even if we don’t agree on all points.

The day began with Louise van Deth from Aidsfonds moderating a panel discussion including Chris Collins from Friends of the Global Fight, Heather Boonstra from Guttmacher Institute and Ann Lefert from NASTAD. The discussion focused on funding, restriction of abortion and family planning services, and the status of efforts to repeal and replace the Affordable Care Act.

U.S. Funding for Global Health

While proposed budget cuts include a possible $240 million from the Presidents Emergency Plan for AIDS Relief (PEPFAR), Collins also reminded attendees that strong Congressional support for the program, and other programs to combat the global HIV and AIDS epidemic, remains strong. In fact, Senator Lindsey Graham, a long time champion of global health, has referred to such cuts as “dead on arrival” in the Senate.

Collin’s advice to the community: leverage this strong Congressional support by helping existing champions stay champions and recruiting new champions. Further, he encouraged the scale up of awareness and education efforts through high visibility events and outreach through grassroots and media channels.  We need to convey how even ‘relatively modest’ cuts are deeply damaging to our work. No cut is acceptable. What comes this year sets the stage for what comes next. We have to maintain the money or it’s going to be hard to get it back.

Update on the “Global Gag” Rule

On the third day of his Administration, not only did President Trump reinstate the “Global Gag” rule, he expanded it beyond its prior forms. It now applies to all global health programs, whereas it previously pertained to family planning. Boonstra referred to this as a “massive expansion.”

To date, it is unclear what impact the rule will have on HIV. It is likely to be extended to PEPFAR, but may have carve outs for the Global Fund. However, it will inevitably affect continuity of care and how U.S. implementing agencies work with local NGOs; there may be fewer local organizations with whom to work as a result, making efforts less efficient and less effective.

In addition, the State Department recently announced that it was ending funding for the United Nations Population Fund (UNFPA). This eliminates $71 million for a range of work in, among other areas, AIDS, sexual and reproductive health and maternal and child health. This, combined with the Global Gag Rule, and the proposed cuts to PEPFAR and the Global Fund, means that we can expect to see an increase in maternal deaths, unintended pregnancies, and the spread of preventable diseases.

U.S. Funding for Domestic AIDS Programs

The national budget, per Lefert, reflects a similar erosion of progress and is laying the groundwork for further inequities. Policy decisions are being pushed down to the state level, which is largely controlled by Republicans. At the national level, the Administration’s appointments offer little reference to HIV.

Though the “skinny budget” included funding for Ryan White programs, it also calls for a $50 million cut for HIV/AIDS research at Centers for Disease Control. As Congress seeks to shift dollars away from other programs in order to prioritize defense and national security, Lefert urged attendees to be wary of smaller cuts that may continue to pare away resources from HIV and AIDS.

Congressional Republicans continue to push for the repeal and replacement of the Affordable Care Act. While their first attempt did not work, the second piece of legislation, still in development, allows for states to apply for waivers in order to opt out of essential benefits. It also includes lifetime caps, annual caps, caps on out-of-pocket costs, and increased underwriting related to age. In addition, it creates an “invisible high risk pool” with $15 billion allocated through 2026 for individuals with preexisting conditions.

Moderate Republicans continue to have issues with this legislation making it unclear as to whether it can pass in the House, let alone how it will fare in the Senate.

What you can do? What is Philanthropy’s role?

 With all of these updates in mind, the panel offered some actionable suggestions for funders:

• Fund Advocacy. Foundations are wavering between filling gaps vs. making long-term policy change, but we need to do both, and to also understand that philanthropy alone cannot fill the gaps that may potentially result from these cuts. We need to fund the advocacy to fight for and leverage government support.
• Provide general operating support. Many organizations rely on that money to respond to the many rapid changes coming from the new Administration. In crisis moments, it’s more needed than ever.
• Understand how these policies and potential funding cuts will impact your grantees. How will the Global Gag Rule affect the small local NGO’s that you support? Analyze your grantees and know where potential crises and gaps may occur.
• Support coalition work. Single organizations have difficulty getting access to high-level members of the Administration and Congress.
• Help to scale up the work of organizations actively mobilizing communities of PLWHA in the response. There are active national, regional and local organizations that have already been successful in mobilizing the voices and actions of the positive community.
• Consider joining or supporting mobilization platforms. Efforts such as the Global AIDS Policy Partnership and the Federal AIDS Policy Partnership
• Create spaces for learning. Help identify, convene and mint new champions to deliver our messages.
• Call our Congressional leaders. As individuals, we can call Congressional leaders and tell them not to cut foreign aid and global health funding (and domestically, to protect the ACA, etc.).
• Collaborate and partner with both likely and unlikely allies. Consider both partners and messages that will connect with corporations, faith-based communities, the military, young people, and different media markets.
• Fund organizations with data capacity. Increase their ability to create data-driven messages that will support the HIV community’s messaging needs

Stay tuned for part two of our review of FCAA’s Spring Convening. In the interim, you can also check out this list of resources and reading discussed during the event.