Miami Herald - July 15, 2004
Fred Tasker, ftasker@herald.com

"This year America is spending nearly twice as much to fight global AIDS as the rest of the world's donor governments combined," Tobias said. "By its actions the United States has challenged the rest of the world to take action."

In early 2003, the Bush Administration pledged $15 billion over five years to fight AIDS, mainly directed toward 12 African countries, plus Guyana and Haiti and Vietnam.

Critics say that isn't enough, pointing to how the U.S. contributions rank 22nd in the world in terms of percentage of its gross national income, behind such countries as Norway, Denmark, Sweden, the Netherlands and Great Britain.

"The $15 billion needs to be increased," said Greg Behrman, author of a study of the Bush program for the Council on Foreign Relations, in a pre-conference interview. "This is an enormous emergency."

Critics contend the United States should give much of that money to The Global Fund to Fight AIDS, Tuberculosis and Malaria, which reaches 124 countries. The U.S. has pledged $1 billion to the fund over five years. By the end of 2003, the fund had nearly $5 billion in total pledges.

Critics also say the U.S. money comes with strings attached that can hamper efforts to curb the spread of HIV - which infected nearly 5 million people last year.

The U.S. money goes to countries that support Bush's abstinence-first policy, and it currently can only buy brand-name drugs, usually American, shutting out cheaper generic versions made by developing countries. Generic drugs can be as much as 80 percent cheaper.

Defending Bush on the condom issue, Tobias repeated to the crowd the "ABC" mantra of many AIDS fighters: "Abstinence works. Being faithful works. Condoms work."

But he added, "Those who want to simplify the solution to just one method - any one method - do not understand the complexity of the problem."

Tobias is Bush's Global AIDS Coordinator.

Dr. Nils Daulaire, president of the Global Health Council, a network of local AIDS prevention and health care clinics in 103 countries, reacted cautiously to Tobias's speech.

"I couldn't agree more with what he said. But now the administration has to put its money where its mouth is."

Daulaire said the Bush Administration has been erratic in funding condom distribution. He said the United States has funded condoms in some countries - Bangladesh, Nigeria, India - but noted the administration and Congress have cut funding from such programs in Kenya and other countries.

Tobias's speech was delayed about 15 minutes while the protesters chanted, "Bush lies while people die," and a few counter-hecklers in the crowd shouted back, "USA number one. F--- off and go home."

Funding the fight against AIDS has been a main topic at the conference here.

The problem is simple: At least 6 million people in poor countries need anti-HIV drugs to stay alive, and only 400,000 are getting them.

The rest can't afford them.

It's not that affluent countries aren't donating money. It's that even the billions they're giving aren't enough, critics charge.

The world should have been spending $6.3 billion a year by 2003 to reach those in need, according to a study by the United Nations Joint Programme on HIV/AIDS (UNAIDS). It spent only $4.2 billion, according to a study by the Henry J. Kaiser Foundation.

It gets worse: The UNAIDS study said $12 billion a year will be needed by 2005 and $20 billion by 2007 to reach those 6 million people. At present rates, those goals will be missed by at least 50 percent, the UNAIDS report said.

That's despite huge, worldwide funding efforts. The Global Fund, for example, was set up in 2002 by the World Health Organization, UNAIDS and the World Bank.

But that group didn't propose to fund the entire need. It and other groups created a "3 by 5" program aiming to treat 3 million people by 2005 - or only half the 6 million who need help.

"The increases are impressive, but they're not sufficient," Princess Mabel van Oranje-Wisse Smit of the Netherlands, director of the Open Society Institute, an HIV advocacy group, told delegates here. "It's not enough to keep up with the AIDS pandemic. Donors must give more."

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