San Francisco Chronicle - July 15, 2004
Sabin Russell, srussell@sfchronicle.com.

Randall Tobias, global AIDS coordinator and director the President's Emergency Plan for AIDS Relief, laid out the key elements of the program in an address to the 15th International AIDS Conference, declaring that, one year after he was appointed to run it, great progress had been made.

"We're moving with urgency," he said. "Already, we are seeing results."

Five-year goal

So far this year, the president's program has disbursed $865 million for new AIDS prevention and treatment programs. Tobias said later that the program expected to be providing AIDS drugs to 200,000 people by the end of next summer, and he insisted that it would meet its goal of providing the medicines to 2 million people five years hence.

His speech came amid controversy over the Bush administration policy to direct most of the $15 billion to a chosen list of countries -- 12 in Africa, two in the Caribbean and Vietnam -- rather than expand support of the Global Fund to Fight AIDS, Tuberculosis and Malaria, an agency created at the request of U.N. Secretary-General Kofi Annan that provides aid to 128 countries.

In an interview with The Chronicle after his speech, Tobias said that, in fact, "the United States is urging the Global Fund to slow down."

Tobias said the Global Fund, which has raised $3.5 billion, already had "a large pipeline" of approved grants.

"If we put more money into the Global Fund right now ... that money is going into an account at the World Bank," he said. "I believe they have adequate resources on hand."

Angry reaction

Stephen Lewis, U.N. special envoy for HIV-AIDS in Africa, reacted angrily to Tobias' interview comments.

"Slow down? It needs to speed up," he said. "It's the most effective instrument against the pandemic."

Lewis said that Bush's program reflected the same "go it alone" approach that had gotten the United States into trouble in Iraq. He predicted that the United States would eventually embrace the Global Fund's multinational approach, just as it is now reaching out to other nations to work with it in Iraq.

The Bush administration is the largest single contributor to the Global Fund, but it is proposing to provide only $200 million next year, down from $540 million appropriated by Congress this year.

"I think the president's budget request for $200 million for next year is just fine," Tobias said.

Yet in his address to the International AIDS Conference, Tobias made a case for setting aside the deep differences in opinions over how to battle the epidemic, which has claimed 20 million lives.

"We are striving toward the same goal -- a world free of HIV-AIDS," he said. "Division is a luxury we cannot afford."

It was a bid for unity he was almost unable to make at all. As he stepped up to the lectern, a group of 30 protesters carrying placards with the words "He's lying" marched in front of the raised stage, heckled Tobias and for 15 minutes ignored pleas by conference organizers to sit down.

Tobias also defended the program's reliance on "faith-based" institutions to distribute local AIDS assistance, noting that the "temples and the monasteries, the churches, the mosques and the synagogues are among those who have gone where no one else would go."

Complexity acknowledged

And he said criticism of the president's so-called ABC program -- an AIDS prevention program stressing abstinence, being faithful to your spouse and the use of condoms -- was based on a misconception that it stressed only one approach.

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

Tobias' "slow down" comment was particularly irksome to AIDS activists, given that much of the conference is devoted to seminars on practical ways to increase treatment and prevention programs to a level commensurate with the scale of the epidemic.

Tobias contends that the Bush's program is the most effective way to do so with American dollars. AIDS protesters strenuously disagree.

"His global AIDS policy is an astounding patchwork of cynicism and pandering to special interests," said Health Gap Coalition activist Asia Russell, who was among those disrupting the start of Tobias' speech.

But Dr. Nils Daulaire, president of the Global Health Council, called Tobias' address "one of the most thoughtful and comprehensive statements of policy and commitment that we have heard." Daulaire said his group "deplores the extremists who tried to drown him out."

Only last month, Daulaire denounced the Bush administration, which cut funding of the group's annual health conference after objecting to discussions of reproductive rights issues slated for the meeting. Daulaire said then that the Department of Health and Human Services had bowed to "a clique of right- wing extremists."

On the deeply controversial question of whether the Bush administration will buy low-cost copies of AIDS drugs made by overseas generic pharmaceutical companies, Tobias reiterated that he would do so if the products can pass muster through an expedited Food and Drug Administration approval system.

He urged the companies making the generics "to file their applications as soon as possible so we can begin funding these drugs as soon as possible."

In the interview with The Chronicle, Tobias said he did not know of any applications for approval, but predicted that generic AIDS drugs would be approved by year's end. He said that competition between generic and brand- name drug makers would drive down the cost of AIDS medications so that it would be possible to get 2 million people under treatment within the program's five-year budget.

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