This World AIDS Day we were greeted by new, more accurate data from the World Health Organization (WHO) confirming the astonishing scope of the global epidemic: Some 40 million are now infected, with 5 million new infections and 3 million deaths in 2003 alone. AIDS is the greatest health crisis in human history–it has long since dwarfed the black plague–and it threatens to become a profound political and economic crisis as well. As Colin Powell said to mark the day, “AIDS can lay waste to whole countries and destabilize entire regions of the world.” Yet within living memory for most of us, AIDS was no more than a small outbreak affecting a few dozen gay men in Los Angeles and New York.

The containment of SARS shows what is possible. By contrast, the AIDS epidemic became what it is today because of a criminal failure of political will. Home to the first identified cases, with enormous resources at its disposal, the United States had a special role to play in halting AIDS while it was still manageable. But because the dying were primarily gay men and drug users, Ronald Reagan wasted most of his presidency without publicly acknowledging the disease. By the time he finally did, in 1987, AIDS had gone global. When antiapartheid leader Thabo Mbeki became president of South Africa, the destructive force of AIDS there was unmistakable; but he, too, dithered away precious years in denial, blocking the efforts of activists to make medicines available. Until recently, the Chinese government responded to its emerging AIDS crisis by jailing those who dared to speak the truth about the nation’s rising number of infections.

But the tide is beginning to turn. Thailand and Brazil have become models within the developing world, the former for its energetic campaign of condom promotion, the latter for its aggressive use of discounted and generic drugs to treat its entire AIDS population. China recently abrogated its own obscenity laws to run television ads about condom use and launched a pilot program to treat impoverished people with AIDS. South Africa has begun implementing a national plan to provide HIV medicines as widely as it can afford. India has announced its first large-scale drug treatment program, an effort to treat some 100,000 of its more than 4 million infected. Former President Clinton has just brokered a deal under which four drug companies will reduce the price of AIDS drugs to poor countries. And with George Bush’s $2.4 billion global AIDS bill, now awaiting a vote as part of Congress’s omnibus spending package, the United States is finally devoting significant resources to the global crisis, a welcome step that would nearly double current aid levels and could make a significant contribution to the WHO’s goal of treating 3 million impoverished people with AIDS by 2005.

Yet Bush and Congressional Republicans have seriously compromised the bill’s potential through their allegiance to corporate interests, social conservatives and a go-it-alone foreign policy. A third of the bill’s prevention dollars are tagged for abstinence-only messages, which forbid the mention of condoms, an indispensable tool wherever rates of infection have been reduced. The money channeled through USAID may not be spent on syringe exchange, a proven strategy for reducing the drug-injection infections that now drive the epidemic in Russia and elsewhere. Churches and missionary operations will receive special consideration in the awarding of grants, while family planning networks, the main source of community healthcare in much of the developing world and the best positioned to deliver HIV care, have been forced to shutter clinics under Bush’s 2001 global gag rule, which ended aid to outfits that mention abortion as an option for women with unplanned pregnancies. Many of the bill’s treatment dollars will be wasted because the Administration continues to support restrictions on the production and export of cheap, generic HIV medications. And the bill continues to starve the UN’s Global Fund to Fight AIDS, TB and Malaria in favor of unilateral aid that can be used for political ends–much of it bound by restrictive “buy American” provisions.

Global AIDS experts estimate that $5.4 billion a year is needed from the United States to do our part to prevent and treat HIV worldwide. Bush and the GOP-led Congress must ante up all of the $3 billion they green-lighted in May. To make that money count, Congress should send the bulk of it through the UN Global Fund and excise dangerous abstinence-only provisions. For his part, Bush must embrace the export of generic HIV medicines to nations hard hit by AIDS, back the cancellation of debt payments that cripple those nations’ health services and openly oppose the Vatican’s war on condoms. After twenty-two years and 30 million dead, real AIDS leadership requires taking political risks.