Growing up in Bennington, Vt., I never expected get a firsthand lesson on the importance of U.S. foreign aid. But as part of my medical training, I spent the past 10 months in Africa, where I saw the transformative effect of U.S. investment in global health.

Now, as Congress discusses foreign aid funding amid concerns that the United States will pull back on its commitment to fighting global AIDS, I think about Thomas, a Rwandan father of two who was brought into the Kigali hospital where I was stationed until May.

Leaning on his brother for support, Thomas was barely able to walk when he first arrived and had been suffering from serious memory lapses. A CAT scan showed that he had a type of brain infection seen in patients with end-stage AIDS. Thomas lived in a remote village far from Rwanda's capital city and had never had an HIV test.

We immediately started him on antiretroviral drugs, made available in large part through the U.S. President's Emergency Plan for AIDS Relief. Started in 2003, PEPFAR has provided life-saving treatment for more than 2 million men, women and children in the developing world. It has provided antiretroviral drugs to more than 1 million pregnant HIV-positive women, allowing their babies to be born HIV-free.

But the program has accomplished much more than saving lives from HIV/AIDS. Throughout the developing world, PEPFAR has fostered self-reliance by building and improving clinics and laboratories. It has strengthened drug supply and delivery systems. It has trained new health care workers who, in addition to providing HIV care, can vaccinate babies, hand out anti-malaria bed nets, and attend to other basic health needs. The impact of our tax dollars has been multiplied by the Global Fund to Fight AIDS, Tuberculosis and Malaria, where each dollar we have contributed has been matched by two dollars from other countries.

Freezing our contribution

In Washington, policymakers are now considering freezing the U.S. contribution to the fund and providing only a modest increase for PEPFAR, which would essentially stall the program's momentum at a critical juncture in the battle against the AIDS epidemic. When Congress reauthorized PEPFAR last year, lawmakers called for boosting spending on AIDS, tuberculosis and malaria; they also broadened the program's mandate to include strengthening health systems in the developing world.

Similarly, the Obama administration has called for a new "comprehensive global health strategy" that envisions bolstering health systems. We cannot afford to backtrack on the promises made in the new PEPFAR law. An estimated 33 million people worldwide are living with HIV/AIDS, but only one-third of those eligible for HIV therapy are getting it. And despite the progress in preventing mother-to-child transmission, only 33 percent of pregnant HIV-infected women in developing countries received the drugs necessary to block the virus from passing to their newborns.

Compounding problems

A slow-down now in U.S. global AIDS funding could compound drug shortages and treatment disruptions already threatening HIV programs in the developing world, where poor patients are at risk of losing access to their antiretroviral medications.

Sens. Patrick Leahy and Judd Gregg are taking the lead role in the Senate in determining how much funding these programs will receive. They should give a major boost to PEPFAR and the U.S. contribution to the Global Fund, or infections like HIV and tuberculosis will spread further in these communities, making control of these diseases much harder down the road.

Hanging in the balance are the lives of people like Thomas, who within three weeks of starting HIV therapy, was walking again. Before I left Rwanda, his brother happily reported that Thomas was "back to normal again." As long as Thomas continues his HIV medication, which he will be able to get at a PEPFAR-supported district health clinic near his home, there is a very good chance he will be able to return to work and support his wife and two young daughters. (next page »)