No Good Deed Goes Unpunished

• Published in: Foreign affairs (New York, N.Y.) Vol. 89; no. 4; p. 74
• Main Authors: Lyman, Princeton N, Wittels, Stephen B
• Format: Magazine Article
• Language: English
• Published: New York Council on Foreign Relations NY 01.07.2010
• Subjects: Acquired immune deficiency syndrome; AIDS; Foreign policy; HIV; Human immunodeficiency virus; Humanitarian aid; Leverage; United States > US; Africa
• ISSN: 0015-7120; 2327-7793

The George W. Bush administration increased annual US assistance to Africa almost sixfold, from $1.3 billion in fiscal year 2001 to $7.3 billion in fiscal year 2009. One-time debt forgiveness and emergency humanitarian assistance contributed to this increase, but it was primarily driven by the President's Emergency Plan for AIDS Relief (PEPFAR), the US' single largest continuing commitment to Africa. PEPFAR, which was originally expected to disburse some $15 billion over its first five years, actually spent $25 billion between 2003 and 2008. If the US continues to lead the international community in filling the "treatment gap," the magnitude of the commitment will steadily grow. And so, too, will the foreign policy problems this kind of aid creates. More aid will limit Washington's influence on issues other than HIV/AIDS in recipient countries. The Obama administration will need to recognize the paradox that in the absence of increases in other forms of aid, more humanitarian assistance will mean less leverage.