United Press International - July 14, 2004
Michael Smith and Ed Susman, United Press International

The U.S. Government Accountability Office -- formerly the General Accounting Office -- reported that duplication of effort, lack of coordination and red tape are hampering the $15 billion plan launched by President George W. Bush in 2003.

The GAO interviewed U.S. personnel in 14 countries and found nearly all were having difficulty working with non-U.S. groups and even with other American organizations.

This has led to "duplicate efforts, confusion regarding standards and heavy administrative burdens," the report said.

Despite the criticism, however, the GAO said the United States was "making overwhelming progress" through the President's Emergency Plan for AIDS Relief, which critics have said undercuts the international Global Fund for AIDS, Tuberculosis and Malaria.

"We've been very alarmed by the approach of the administration to set up a parallel delivery system," said Paul Zeitz, executive director of the Global AIDS Alliance. He added it is leading to a "fragmented, low-impact, incoherent response" to the AIDS epidemic.

"Decisions are made in Washington, and sometimes even the local ambassador doesn't know what's going on," he said.

Zeitz said, however, the GAO report was not nearly as scathing as U.S. AIDS workers are in private.

"I think they (GAO) were as critical as they could be," he said, given the report was generated by a government agency.

The former AIDS czar under the Clinton administration, Sandra Thurman, said the report holds no surprises for anyone familiar with the AIDS epidemic.

"Even when I could do something about it, it was like herding cats" to coordinate AIDS efforts, she said.

The United States has been under attack at the Bangkok conference for its go-it-alone attitude, its insistence that abstinence from sex form the basis of prevention programs, and for its last-minute decision to forbid most of its scientists from attending the meeting.

During a lecture at the conference, Ambassador Randall Tobias, Bush's U.S. global AIDS coordinator, said to reduce some of the red tape, small local organizations will be able to apply directly for funds from local embassies.

"The idea of this program is to ensure that small and effective organizations that are doing some of the best work on the ground can get money fast to address the urgent needs within their communities," he said.

Tobias' speech was delayed for about 15 minutes while a group of some 100 protesters shouted slogans and held signs calling Bush a liar and demanding the administration immediately spend $30 billion on world AIDS projects. Others in the audience booed the protesters.

Eventually, at the urging of Dr. Joep Lange, president of the International AIDS Society, and with the applause of the audience, the protesters sat in front of Tobias as he spoke. They shouted comments throughout his talk but he was able to complete the speech -- unlike what happened to U.S. Secretary of Health and Human Services Tommy Thompson, who was drowned out when he spoke at the conference two years ago in Barcelona, Spain.

Thurman said some of the administration's ideological positions -- its distaste for condom distributions, for example -- make it difficult to create broad, successful prevention programs.

McGill University Professor Mark Wainberg, a former president of the International AIDS Society, said the lack of coordination is worrisome but is not limited to the U.S. effort.

He was sharply critical, though, of the U.S. decision to prevent many of its scientists from attending the conference, which is viewed as a deliberate snub. The result of the boycott is the Bangkok meeting will have less impact than previous conferences, he said.

Wainberg is chairman of the committee organizing the next International AIDS Conference, to be held in 2006 in Toronto. That meeting, he said, should have a greater scientific impact, if only because it's unlikely the United States would boycott two in a row.

--

Michael Smith and Ed Susman cover medical policy and research issues for UPI Science News. E-mail sciencemail@upi.com
040714
UP040716

Always watch for outdated information. This article first appeared in 2004. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2004. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .