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AIDS groups praise U.S. for committing billions globally
Some question how money will be spent
Despite the Iraq war and an unimpressive HIV/AIDS domestic budget, President George W. Bush and the U.S. Congress kept their promise to earmark billions for international HIV/AIDS treatment and prevention.
When Bush met with the world’s wealthiest nations at the G-8 summit held in France in June, he showed them the United States’ $15 billion international HIV/AIDS commitment and asked them to ante up.
"The president’s relief plan is a very important piece of legislation," says Marsha Martin, DSW, executive director of AIDS Action in Washington, DC.
"It has changed the focus from prevention to treatment and dedication to build a global infrastructure to respond to this epidemic," Martin says.
Other AIDS organizations offered similar praise. "We are very enthusiastic supporters of the Global AIDS initiative that the U.S. is doing, and we worked on shaping the language of that legislation," says Michael Weinstein, president and founder of AIDS Healthcare Foundation in Los Angeles. AIDS Healthcare Foundation is the nation’s largest AIDS organization, with 14 clinics in the United States and clinics in Uganda, South Africa, and Honduras.
"Legislation is always a compromise, and there are aspects we’re not enthusiastic about, but overall it’s an enormous advance," Weinstein says.
Praise also was heard from the Population Research Institute (PRI) of Front Royal, VA, an organization that promotes stand-alone sexual abstinence programs as part of contraceptive and HIV-prevention strategies.
"We definitely need a new approach, and this law is the first step toward this new approach, because it can establish HIV/AIDS programs that are a solid function of basic health, as opposed to a function of reproductive health," says Scott Weinberg, director of governmental/international affairs for PRI.
However, the bill has some critics, primarily because of the way the money is distributed and the strings attached to it.
"The $15 billion is confusing; it’s $10 billion new dollars, and a lot of it is shifted from other budget items and other development aid," says Asia Russell, coordinator of international policy for Health GAP in Philadelphia.
"Also, the funding schedule has the money back-loaded," Russell says. "It doesn’t meet the $2 billion per year mark for a couple more years."
Maneuvering by the House Appropriations Committee has also left it unclear whether the $15 billion commitment would survive last-minute foreign aid budget cuts. And the bill’s authorization for up to $1 billion for the Global Fund is not a mandate. The amount that the United States will contribute cannot total more than one-third of the fund’s total contributions, which so far have been disappointing, AIDS advocates say.
Russell argues that the U.S. money would be better spent on the Global Fund, to which the U.S. gave $350 million in 2003. "Bush only wants to spend $200 million a year now on the Global Fund for the next five years, and that’s as much as it cost to make the movie Titanic," Russell says.
Although the bill permits the United States to give up to $1 billion to the Global Fund each year, Russell and others say it’s unlikely that much will be donated.
"What we know is the White House does not intend to spend $1 billion in 2004 on the Global Fund," Russell says. "There was bipartisan amendment language on the Senate floor to put more money into global AIDS in 2004, and the president opposed it."
Another source of contention is the fact that the funding bill was passed with an amendment that would earmark one-third of the prevention money for abstinence-only programs.
"It’s never acceptable when effective, science-based, life-saving interventions recommended by experts are hijacked for the life-threatening political interests of extremist elements in the U.S.," Russell says. "It sends a horrible message to folks in the trenches, who recognize that you don’t make a decision like that when you’re fighting a plague."
Uganda’s success attributed to abstinence
Advocates for abstinence-only prevention programs point to Uganda’s successful "ABC" prevention program and say its success is due mainly to the "A," which stands for "Abstinence." They discount the other two letters of the program’s acronym, which stand for "Being faithful" and "using Condoms."
"Uganda has worked because Uganda focuses on abstinence, and like the first lady of Uganda says, they are not going to entrust the future of their civilization to latex," Weinberg says.
Not everyone agrees with this interpretation.
"My only problem with abstinence only’ is the only’ part," Weinstein says. "I don’t think we ought to segment our efforts into only condoms’ or only abstinence,’ because the magic in the whole equation is putting them together, sort of like a drug cocktail."
PRI officials maintain that condoms could be left out of the picture altogether.
"It’s self-evident that the program works because of abstinence," Weinberg says. "If you don’t have sex, you can’t have HIV, and 20 years of condom promotion have only shown that approach has been a complete betrayal of millions of innocent lives."
Weinberg points to a Lancet study as proof that condom use and safer-sex-behavior programs haven’t affected the HIV rate among adults in Uganda. The study, published this year, found no effect on HIV incidence between two intervention groups and a control group, despite the fact that the intervention groups had significant reductions in acute syphilis, gonorrhea, and unprotected casual sex.
The study’s authors note that the surprising HIV results could have been due to the fact that HIV incidence was already declining in Uganda at the time the study was conducted, so the difference in HIV incidence between groups that had increased their safer sex behavior and the control group was not substantial.
There is another reason to accept the abstinence-only amendment and move on to more important matters, however, Martin notes.
"The one-third going toward abstinence got 100 votes for the bill," Martin says. "One-third of prevention money goes toward abstinence, and 80% of the total funds go toward treatment, so that one-third amount isn’t large enough to fall on your sword for."
Plus, the abstinence-only programs are going to be directed toward adolescents, Martin adds.
"If it helps them delay their first sexual experience, then I’m all for it," Martin says. "But let’s also work to make sure the 80% works for care and treatment."
Some of the international AIDS money is earmarked to be distributed to faith-based organizations, a prospect that bothers some First Amendment advocates but that does not bother Martin at all.
"The government has been giving money to religious institutions for years," Martin says.
For example, the Salvation Army is a religious institution that receives taxpayer funding, including direct funds from New York City, Martin notes. "And the Metropolitan Community Church in San Francisco is getting money from the state to provide services to gay people," Martin adds.
The Bush administration has also indicated its support for generic or very cheap HIV drugs, and it remains to be seen whether poor nations will be able to produce or buy cheap drugs, Russell says.
"The hypocrisy in that is that, at the same time, the U.S. has been blocking key access to portable generic medicines, so if a country doesn’t have sufficient capacity for generic production, they couldn’t get export versions of the medicines," Russell says.
Despite these gray areas in the new bill, the bottom line is that it took President Bush’s intervention to get Congress to pass legislation that will send billions of dollars to programs combating the AIDS epidemic, AIDS advocates say.
"Talk is cheap, and the U.S. was not doing enough, and people were surprised that Bush so prominently used his State of the Union message to say he was going to work to increase AIDS funding," Weinstein says. "We think this is a revolution in HIV treatment for the world."