'We're Ready'

In his 2003 State of the Union address, George W. Bush surprised and delighted AIDS activists by pledging $15 billion over five years for an emergency AIDS relief plan in more than a dozen hard-hit countries in Africa and the Caribbean. But in this year's speech, as the President ticked off a list of his accomplishments--the fall of Baghdad, the capture of Saddam, and the expansion of drug coverage for seniors--there was no mention of AIDS. That came as little surprise to his critics. Since the announcement of Bush's high-minded sounding emergency plan 12 months ago, another three million people worldwide have died of AIDS--but not a penny of the money he pledged to fight the disease has been released from the U.S. Treasury.

What was meant to be a bold display of American generosity to the world is at risk of turning into a public relations disaster for Bush. In his 2003 speech, the president pledged the monies would assure the treatment of "at least 2 million people with life-saving drugs." But the Global AIDS Alliance estimates that just 1,000 people overseas have received treatment funded by the United States over the past year--all from programs that predate Bush's big announcement. Last fall, Stephen Lewis, the United Nation's top AIDS official, said he was enraged that "rich powers" like the United States were still neglectng the crisis in Africa. Yet, the administration's office of the Global AIDS Coordinator still operates with a skeleton staff borrowed from other departments while dozens of its positions remain unfilled.

Not only has the money been slow in coming, but Bush's plan itself has been sharply criticized for being too unilateral, fueling fears that it will lure attention and resources away from more multilateral efforts like the U.N.-backed Global Fund to Fight AIDS, Tuberculosis, and Malaria.

Part of the blame for the hold-up falls on Congress, where an omnibus spending bill that would deliver the first installment of $2.4 billion remained stalled until late last week. But while Bush--to much fanfare--authorized Congress to spend up to $3 billion on AIDS this year, the administration lobbied lawmakers privately to hold that appropriation to $2 billion. They eventually compromised on $2.4 billion. The administration's rationale: time is needed to build healthcare infrastructure in the targeted 15 AIDS-stricken countries so that the money can be utilized effectively. Over five years, the plan is to not only provide anti-retrovirals to 2 million victims of the disease, but to prevent an additional 7 million from contracting the virus and to provide care for 10 million more, including AIDS orphans, who are affected indirectly. That sounds good in theory. But the Global Fund, a two-year-old program created with help from the U.S. and U.N. Secretary General Kofi Annan that now works in 120 countries, says it has the capacity to effectively spend the full $3 billion--and then some--right now. The administration, however, prefers to distribute the money through U.S. aid agencies, even if that means getting to work more slowly. It proposed giving the fund less than seven percent of its overall AIDS package, an amount which even Republicans in the House thought too stingy. (Led by Rep. Jim Kolbe (R-AZ) they voted to nearly triple President's request for the fund to $550 million this year.)

Activists say the administration views the Global Fund with the same hostility it revealed toward the U.N. in the run-up to the Iraq War. Rather than distribute the money through a respected, multilateral institution, the administration's plan would dispense the lion's share of the funds through U.S. aid agencies. The problem with that, as Paul Zeitz of the Global AIDS Alliance points out, is that while poor countries in Africa could absorb more assistance, USAID and other American agencies don't yet have the capacity to hand out such huge sums. The Global Fund, with an 18-month head start, is better equipped to spend the money wisely. Zeitz and others say the administration is hesitant to direct much of the money to the Fund because it would then have to share credit for saving lives with other countries. But in going it alone, the administration could wind up building a parallel bureaucracy that will--in effect--compete with the Global Fund. This approach, while perhaps better politically for the President, could imperil the Global Fund. With only limited support from the world's richest nation and lone superpower, the fund might have trouble attracting sizeable contributions from Europe and Japan.

Another reason the administration prefers to distribute the aid unilaterally is that it can then spend it on programs that fit its socially conservative agenda. A third of the money to be spent for prevention is for "abstinence-only until marriage" programs. Few would argue that encouraging at-risk teenagers to delay their first sexual experience is a bad thing. But those most at risk for developing AIDS in many developing countries are sex workers, homosexuals, and IV drug users--a population less likely to attract sympathy from conservative politicians than youngsters. Several successful programs, like those in Uganda run by the government and a host of international aid agencies, have taken a more integrated approach, preaching not only abstinence but sexual fidelity and condom usage. AIDS rates there have dropped from an estimated 20 percent of the population to 6.5 percent.

Despite all this, even the administration's harshest critics admit that it must be lauded for proposing such a bold initiative. Bush's plan, though hampered by unilateralism and ideology, is vastly more ambitious than anything offered by the Clinton administration. As Bush launches into campaign mode, his opponents are unlikely gain much traction on the issue. The AIDS epidemic isn't a top priority for most voters, and Democrats share part of the blame for stalling the initiative's funding in Congress. But for an administration viewed skeptically, and often angrily, by those beyond American borders, the president could do more to halt the erosion of good-will generated by last year's promise.

Bush's No. 2 AIDS man, Joseph O'Neil, says that his office is ready to take the first steps. He told NEWSWEEK that he is prepared to immediately fund more than a third of a billion dollars in AIDS grants as soon as his office receives the money. "We're hugely frustrated we don't have the appropriation yet," he says. "We're ready." So are the world's AIDS' sufferers.