Wall Street Journal - May 14, 2003
John Harwood

Mr. Bush will capitalize on the war against AIDS -- the one the world is losing. He has demanded passage of a five-year, $15 billion U.S. commitment to the global pandemic by Memorial Day. If he gets it, and he is likely to, it will be a political coup on all fronts.

Internationally, it will show the coming Group of Eight industrialized nations' summit that Mr. Bush will deploy America's "soft power," after turning its hard power on Iraq in the face of world opinion. At home, it gives flesh to the oft-neglected front end of his "compassionate conservative" agenda. It's a winner with women swing voters who weren't so amused by the president's recent strut across an aircraft-carrier deck in a flight suit. And it steals an issue from his 2004 Democratic rivals.

Yet veterans of President Clinton's administration are applauding. Sandra Thurman, Mr. Clinton's White House AIDS adviser, hails the "unprecedented ... opportunity" to slow a disease that has ravaged Africa and could produce some 45 million new infections world-wide by 2010. The initiative "showed leadership that was striking," adds Steve Morrison, an Africa specialist in Mr. Clinton's State Department.

The issue involves security concerns as well as moral and political ones, extending far beyond the U.S. or Africa. Writing in the journal Foreign Affairs, demographer Nicholas Eberstadt warned recently that "the center of the global HIV/AIDS crisis ... will shift from Africa to Eurasia" over the next generation, potentially destabilizing Russia, China and India.

It is rare that the needs of the international community and the imperatives of U.S. politics are so auspiciously aligned. Polls show Americans believe U.S. foreign aid is 20 times larger than its actual share of less than 1% of the federal budget, and want it reduced.

Politicians, in turn, exaggerate that level of resistance.

The result: The U.S. devotes proportionately less to assistance abroad than its industrialized counterparts in Europe. As recently as 1998, Mr. Morrison notes, the Clinton administration was spending less than $150 million per year to fight AIDS internationally.

That a conservative Republican president would pledge 20 times that much -- amid economic anxiety and swelling budget deficits -- is the product of converging trends. Conservative Christians, important in Mr. Bush's base, have shown increasing interest in Africa's agony. Media coverage sent mainstream opinion surging ahead of political leaders on the need to act more aggressively. Secretary of State Colin Powell bested administration hard-liners in elevating the priority of the issue with Mr. Bush himself.

Two final elements fell into place as the president prepared to deliver his State of the Union Address in January. Bungled Iraq diplomacy gave Mr. Bush added incentive to soften his image as a cowboy Texan. And the ascent of surgeon-politician Bill Frist to Senate majority leader provided an ally with the motive and ability to deliver.

A successful AIDS initiative will steepen the Democrats' climb to defeat Mr. Bush next year. Sen. John Kerry of Massachusetts, who earlier sponsored unsuccessful relief legislation with Mr. Frist, attacked Mr. Bush early this year for ignoring AIDS in deference to "political calculation and conservative dogma." Now Mr. Bush has largely silenced that line of attack. In the recent Democratic presidential debate in South Carolina, the AIDS crisis wasn't mentioned by Mr. Kerry or anybody else.

Political adversaries will learn over time whether their skepticism about Mr. Bush's commitment is justified. Funding for the initiative is "back-loaded," which means election pressures or shifting financial demands could erode willingness later to spend all the money pledged.

Part will be frittered away in any case, some AIDS activists maintain, if Mr. Bush persists in seeking to spend so much on new unilateral efforts rather than work through the United Nations-linked Global Fund. There's good reason to doubt at-risk Africans will heed calls for sexual abstinence from conservative House Republicans, who have earmarked for that purpose one-third of the initiative's fund aimed at prevention. The Senate is preparing to act on the House bill, which passed with an unusual bipartisan majority.

Nor is Mr. Bush's pledge enough to fully attack a disease that has infected roughly 68 million people, killing more than one-third of them, in two decades. The Global HIV Prevention Working Group has called for an annual increase of $3.8 billion in spending on prevention, far more than Mr. Bush would devote to that purpose.

"We probably need 10 times" what Mr. Bush has proposed, Ms. Thurman says.

But American politics doesn't often serve up more than small favors at a time. And the realization of Mr. Bush's initiative wouldn't be a small one.

Write to John Harwood at john.harwood@wsj.com
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