Newsday - January 30, 2003
Laurie Garrett and Samson Mulugeta, Staff Writers

The current U.S. donation to the Global Fund to Fight AIDS, Tuberculosis and Malaria - an international effort created a year ago at the urging of UN Secretary-General Kofi Annan - is $380 million. But instead of that multilateral approach, the president "wanted a project that was both feasible and accountable," said Dr. Anthony Fauci, who directs the National Institute of Allergy and Infectious Diseases.

Fauci spearheaded the design of this new effort, which is modeled closely on the AIDS treatment program created by Dr. Peter Mugyenyi in Kampala, Uganda, Fauci said in an interview. Mugyenyi was a guest of the president Tuesday night at the State of the Union address.

"This is not parachuting a Western medical model into an African country," Fauci said. Rather, the White House hopes to direct the bulk of funding via the State Department, which would use it to beef up existing treatment and prevention infrastructures in the targeted countries: Botswana, Ivory Coast, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia.

For activists such as Salih Booker, Bush's pledge sparked a euphoria tempered by concerns that the funds would not necessarily be released in time to save the lives of millions, citing a previous $5 billion announced with fanfare but eventually buried in political wrangling between the White House and Capitol Hill.

"In the past, the administration has used an Arthur Andersen form of accounting," said Booker, executive director of Africa Action, an advocacy group in Washington, D.C. "They project money that will be spent way into the future while people are dying today."

Missing from the list of countries that will benefit from the latest program are many hard-hit nations: Zimbabwe, Malawi, Swaziland, Angola, Lesotho, and Burundi, each of which has HIV rates of 25 percent to 35 percent of their adult populations. Fauci declined to comment on how the nations were selected.

"You can't do it all," he said.

Still, some are hopeful that the world's richest nation is now ready to lead the international fight against AIDS. Stephen Lewis, the UN's special envoy on HIV/AIDS in Africa, hailed Bush's announcement as "the first dramatic signal from the U.S. administration that it is now ready to confront the pandemic and to save or prolong millions of lives."

"It gives leverage to activists everywhere to keep the pressure on," Lewis said. "It transforms the response; it opens the floodgates of hope."

Lewis said he hoped the decision from Washington - the world's biggest donor - would push other rich nations to open their coffers.

"The international financial delinquency that has haunted the response to AIDS in Africa is hardly that of the United States alone; it extends, without exception, to all the wealthy donor nations," he said.

In South Africa, which has more HIV-positive people - 4.7 million - than any other country, Bush's announcement was welcomed as long overdue.

Mark Heywood, secretary of Treatment Action Campaign, a nonprofit AIDS advocacy group based in Johannesburg, expressed concern that most of the new money was scheduled to be spent bilaterally - as direct aid to affected countries through the State Department - instead of going through the Global Fund.

The UN-administered fund is seen by some advocates as more efficient in distributing the money than many of the African governments, which have varying levels of professionalism.

"We welcome every new dollar, but in this case we're critical," Heywood said.

Bush's announcement comes as the Global Fund board is meeting in Geneva to dole out its second round of HIV treatment and prevention grants. Once this latest round of grants is completed, the Fund will be bankrupt, according to its director, Dr. Richard Feacham.

A notable feature of the fund's approach is its willingness to give grants to nongovernmental organizations, including those implementing programs under attack from their own governments, such as South Africa and Zimbabwe. The fund's leaders spent two years creating systems of accountability in order to limit corruption and to please donating wealthy countries, primarily the United States. Further, the Fund deals not only with AIDS, but also malaria and tuberculosis.

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