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

BANGKOK, Thailand - In a fractious session at an international AIDS conference here, U.S. AIDS czar Randall Tobias on Wednesday defended President Bush's global program for fighting AIDS, while about 50 protesters sat on the floor holding up signs that read, "He's lying."

"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, Haiti and Vietnam.

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

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

Critics say the U.S. should give much of that money to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which reaches 130 countries. The United States 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 complain that the U.S. money comes with strings attached that can hamper efforts to curb the spread of HIV, which infected nearly five million people last year.

ABSTINENCE POLICY

The U.S. money goes to countries that support Bush's abstinence-first policy, and those funds 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, the former CEO of Eli Lilly and Company and a former director of Knight Ridder, is Bush's global AIDS coordinator.

Dr. Nils Daulaire, president of the Global Health Council, a network of AIDS prevention and healthcare clinics in 103 countries, reacted cautiously to Tobias' 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 has cut funding from such programs in Kenya and other countries.

Tobias' 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.

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

MORE MONEY NEEDED

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 Program 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 six 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 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.

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