George W. Bush’s surprise State of the Union announcement of $10 billion in new funding for the global AIDS crisis was masterful, lending an air of humanitarian internationalism to his bellicose foreign policy. The White House, however, offered scant information on its Emergency Plan for AIDS Relief, and the all-important details will have to be worked out by Congress in the weeks ahead. In the meantime, AIDS activists responded with a mixture of guarded optimism and suspicion, and rightly so. Bush’s announcement does mark a significant shift, for the first time embracing treatment as a viable and legitimate goal, as well as, apparently, the use of generic drugs. But for Bush’s words to translate into an effective AIDS plan, the Administration will have to reverse course on a number of its policies.
Of primary concern is the Administration’s record of duplicity on AIDS funding. As Africa Action director Salih Booker points out, the White House uses “Arthur Andersen-style accounting methods, counting old money several times and using projections for sums that don’t yet exist” when announcing “new” aid packages. Indeed, according to the Wall Street Journal, Bush’s “budget for 2004 would reduce by about the same amount the funding that aides had said would be sought for a separate development-aid initiative for poor nations.” Moreover, Bush’s new funding is spread over five years and begins in 2004 with only a modest increase over prior levels–less than what was authorized by the Frist-Kerry bill, which passed the Senate last year only to be scuttled by the White House.
This isn’t the first AIDS smoke-and-mirrors ploy from this Administration. In June Bush announced to great fanfare a $500 million initiative to reduce mother-to-child HIV transmission in Africa. But just weeks earlier he had personally intervened to reduce the mother-to-child funds in a bill sponsored by, of all people, Jesse Helms. The treatment-access group Health GAP reports that this initiative has yet to receive any funding and is tied up in budget negotiations.
Equally troubling is Bush’s decision to bypass the multilateral Global Fund, instead earmarking 90 percent of new funding for bilateral aid agreements with fourteen African and Caribbean countries. Bush’s announcement couldn’t have come at a more critical time for the fund. Having just awarded $866 million in its second round of grants, the fund reports that it “lacks the resources to approve a third round of proposals.” According to the fund’s Anil Soni, it needs at least $6.3 billion over the next two years. AIDS activists have called on the United States to contribute $2.5 billion of that sum, but the Administration plan offers a mere $200 million a year. Bush’s unilateralism and parsimony are all the more puzzling, since within days of his speech, Health and Human Services Secretary Tommy Thompson was appointed the fund’s chair, putting him in charge of fundraising. Thompson’s elevation is at odds with Bush’s rebuff of the fund, but Asia Russell of Health GAP says it creates some leverage for activists. “Thompson is making a commitment as a public health official to devote energy and resources to combat the greatest health crisis of our time, and we’re going to hold him to his words in terms of policy and funding.”
At best, Bush’s plan creates a parallel and redundant funding mechanism that will compete with the Global AIDS Fund. At worst it will be modeled after existing USAID programs, opening the door for right-wing and Big Pharma lobbyists, who will pressure Bush to renege on his pledge to include generics and condoms in treatment and prevention programs, both of which are standard elements of Global Fund grants. As recently as this past December, US delegates blocked a WTO plan to allow developing countries to import generics for national medical emergencies, and USAID currently has a buy-American-only policy that will have to be revised or evaded if Bush truly intends to purchase generics with US dollars.
Also of note, this past summer Bush stripped the UN Population Fund (UNFPA) of $34 million at the request of Republican House members who alleged that UNFPA supported coerced abortions in China–which UNFPA denies–and then shifted that funding to USAID. Many of the same lawmakers also wanted to deny USAID funding to the Population Council for not using abstinence-based HIV prevention programs. Right-wing abstinence groups, including those federally funded by Bush’s domestic abstinence-until-marriage program, have taken a keen interest in prevention programs in Africa. They single out abstinence education as the key reason for Uganda’s significant reduction of HIV incidence rates. However, Uganda’s prevention program combines abstinence and behavior change with condoms, and the most comprehensive data suggest that all three were responsible for lower HIV rates and that abstinence was a negligible factor for those already sexually active.
The fight against global AIDS now turns to Congress, where presidential hopeful John Kerry and Senate majority leader Bill Frist are among the key players. They, along with Congressional Democrats and sympathetic Republicans, must be pressed to insure that Bush’s rhetoric becomes reality–and starts by appropriating real money to advance public health, not a political agenda.