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Fight Looms Over Global AIDS Program
By Jim Abrams
The Associated Press
Saturday 02 February 2008
Washington - A five-year, $15 billion effort to combat AIDS in Africa and other
areas - arguably the most important and popular international program of the
Bush presidency - may become a political battleground as it comes up for renewal.
President Bush wants to double and House Democrats want to triple spending
on a program that is now treating 1.4 million people, most of them in sub-Saharan
Africa, where he will visit in two weeks.
Democrats also want to slash spending on a multimillion-dollar component that
emphasizes sexual abstinence. And that has conservative groups furious.
The president used his State of the Union address this week to repeat a request
he first made last May that Congress double global AIDS money to $30 billion
over the next five years.
"We can bring healing and hope to many more," he said.
Bush, who will visit Africa in mid-February, gets no argument on that point
from advocacy groups or lawmakers in both parties. They've been hailing the
program since he first promoted it and Congress passed it in 2003.
"There is no nation on the planet which would have made a remotely comparable
effort," House Foreign Relations Committee Chairman Tom Lantos, D-Calif., said
at one of several hearings on how to expand the program.
The President's Emergency Plan for AIDS Relief - or PEPFAR for short - focuses
on 15 mostly sub-Saharan African nations. Lantos' committee plans to vote this
month on a bill to triple spending on it to $50 billion over five years, a sum
that AIDS groups say is closer to the needs of meeting the continuing health
crisis.
Democrats have angered conservative groups with plans to remove a provision,
inserted by the then-GOP controlled Congress five years ago, requiring that
one-third of HIV/AIDS prevention money go to abstinence programs.
That's about 7 percent of all spending. Another controversial provision that
could come out forbids grants to groups that provide medical care to prostitutes.
With Bush's problems in Iraq and elsewhere around the world, the AIDS program
"is something that could very much be his legacy internationally," said Tom
McClusky, vice president of government affairs at the socially conservative
Family Research Council.
McClusky accuses Democrats of trying to change the program into a bill that
would promote sex trafficking and fund family planning programs that are involved
in abortion. "I don't think that's the legacy the president wants."
Sen. Dianne Feinstein, D-Calif., said the current rigid funding requirements
"have placed politics above science." She said that "the administration's
abstinence-before-marriage earmark shortchanges the prevention programs that
are most effective," citing findings of a Government Accountability Office
report.
"We have a tremendous fight on our hands," said David Bryden, spokesman for
the Global AIDS Alliance.
Bryden also has a different perspective on Bush's assertions about doubling
spending. In this fiscal year 2008, the last of the $15 billion program, Congress
approved $6 billion for bilateral AIDS work and the international Global Fund
to Fight AIDS, Tuberculosis and Malaria. He said the White House will be locking
in that $6 billion a year figure in order to reach $30 billion over the next
five years.
The Alliance says that a better funding level over five years would be $59
billion, including $9 billion set aside for malaria and tuberculosis programs.
There were 155,000 people in the 15 focus countries of the program receiving
antiretroviral treatment in 2004, a number that reached nearly 1.4 million people
by September last year.
But with more than 40 million people around the world infected with HIV or
living with AIDS, the crisis has hardly abated. The White House says $30 billion
in spending will extend treatment to 2.5 million people and prevent 12 million
new infections.
Some experts also worry that high-profile AIDS programs will soak up too big
a share of scarce health care dollars. "I'm hard pressed to think of anything
in recorded history on the scale of it," Laurie Garrett, senior fellow for
global health at the Council on Foreign Relations, said of the AIDS initiative.
"How do you target one disease without it being at the expense of other diseases?"
she said, citing the pressing needs in Africa for maternal and child health
care programs, clean water and sanitation efforts, and more health care training
and infrastructure improvements.
U.S. Global AIDS Coordinator Mark Dybul told the House Foreign Relations Committee
last year that the AIDS money contributes, directly or indirectly, to a wide
range of nutrition, TB, malaria, women's health, clean water and education programs.
"HIV/AIDS does not exist in a vacuum," he said. "It is inextricably tied
to other threats to public health, and it has ramifications for a wide range
of development-related issues."
The Global AIDS Alliance's Bryden agreed that the AIDS grants from the U.S.
have led to broad improvements in general health care delivery. The real need,
he said, is to "enlarge the pie" to ensure that every health issue gets the
proper attention.
On the Net:
President's Emergency Plan for AIDS Relief: http://www.pepfar.gov
Global AIDS Alliance: http://www.globalaidsalliance.org/
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