Jim Lobe
WASHINGTON, May 30 2007 (IPS) – U.S. President George W. Bush Wednesday called for Congress to double spending on his global AIDS programme to 30 billion dollars from fiscal 2009 through 2013.
US Global AIDS Coordinator Mark Dybul at St. Bridget s Preschool in Tonota, Botswana. Credit: US State Department
In a brief appearance in the White House Rose Garden, Bush said his four-year-old President s Emergency Programme for AIDS Relief (PEPFAR) is currently providing life-saving drugs to some 1.1 million HIV-infected people in 15 target countries and that the additional spending would permit that number to rise to almost 2.5 million.
America will work with governments, the private sector, and faith- and community-based organisations around the world to meet measurable goals to support treatment for nearly 2.5 million, to prevent more than 12 million new infections, and to support care for 12 million people, including more than five million orphans and vulnerable children, he declared.
He also announced that his wife, First Lady Laura Bush, would travel next month to four recipient countries Zambia, Senegal, Mali, and Mozambique to review the programme s operations there.
AIDS activists cautiously welcomed Bush s statement, although some said that doubling assistance was not sufficient given the rate at which HIV-AIDS was spreading.
Thirty billion dollars over five years would actually result in an overall decrease in the percentage of people with HIV on treatment because of U.S. investments, said Paul Davis of the Health Global Access Group (Health GAP).
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He noted that Bush had promised both at the 2005 Group of Eight (G-8) Summit at Gleneagles, Scotland, and again at the U.N. General Assembly one year later, to work toward universal access to treatment for HIV victims. The U.S. share of the cost of keeping that promise will cost at least 50 billion dollars over the next five years, he said.
Other critics stressed that eliminating various conditions on PEPFAR funding, particularly specific earmarks for abstinence-until-marriage programmes to prevent the spread of the disease, would permit greater funding for projects, such as promoting safe-sex practices, that have proven more effective. PEPFAR currently requires that one third of its HIV-prevention programmes or about 100 million dollars a year be spent on abstinence-until-marriage programmes.
Increased funding for global AIDS is a necessary but far from sufficient response to the global AIDS epidemic, said Jodi Jacobson, executive director of the Washington-based Centre for Health and Gender Equity (CHANGE). No amount of money will make up for the ideologically driven prevention policies now promoted by PEPFAR.
Today, unprotected sex is the single greatest factor in the spread of HIV worldwide, and is responsible for 80 percent of new infections in sub-Saharan Africa, but the Bush Administration insists on funding abstinence-only programs that have now been discredited by the Institute of Medicine, the Government Accountability Office, and numerous independent research studies, she added.
Bush s request, which, if approved, would extend PEPFAR s life to 10 years, came on the eve of next week s G-8 Summit in Heiligendamm, Germany, where key development issues, including debt relief, global health challenges, and climate change are expected to dominate the agenda. Some analysts here suggested that Bush s request was designed in part to divert attention from his administration s efforts to water down a strong G-8 statement on climate change.
Since Bush first announced PEPFAR in 2003, Congress has appropriated more than 13 billion dollars for the programme far more than any other country has contributed to global anti-AIDS efforts. He has requested 5.4 billion dollars, which Congress is virtually certain to approve, bringing to 18.3 billion dollars for the five years of its existence 3.3 billion dollars more than Bush originally requested.
The programme, which expires in September, 2008, focuses on 12 African countries: Botswana, Cote d Ivoire, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia. It also gives funding to Haiti, Guyana and Vietnam.
PEPFAR has also contributed albeit relatively little to the chronically under-funded Global Fund to Fight AIDS, Tuberculosis and Malaria, a Geneva-based multilateral initiative that provides rapid funding to proven projects both by national governments and non-governmental organisations (NGOs).
Because the Global Fund has not applied the same ideological restrictions on AIDS-related funding as those used by PEPFAR, the administration has resisted efforts by Congress to increase Washington s contribution. Thus, for fiscal 2008, Bush has asked Congress to earmark only 300 million dollars of the total 5.3 billion dollars PEPFAR request for the Global Fund, but Congress, as it has in past years, is expected to at least double that amount.
In March, an independent panel of experts led by the Institute of Medicine of the National Academies of Science here gave PEPFAR high marks for addressing the global AIDS crisis, concluding that it had demonstrated what many doubted could be done.
At the same time, the panel assailed various aspects of the programme as ineffective or even counterproductive, particularly its ideological restrictions, such as the requirement that one-third of all money earmarked for prevention strategies be spent on teaching chastity and fidelity, even in countries where AIDS was spread mostly by drug use.
The panel also criticised PEPFAR s requirement that the U.S. Food and Drug Administration separately approve all anti-AIDS drugs that have already been approved by the World Health Organisation (WHO) for use on HIV-infected patients. The administration has tried to accelerate the approval process.
In addition to eliminating such restrictions, Health GAP called on the administration to increase funding for training, retaining and supporting the growing number of medical personnel and community health workers who are needed to fight the disease, particularly in Africa.
There is a catastrophic shortage of health workers in Africa, and unless PEPFAR commits to spending new money to to address this crisis, the U.S. will not be able to meet its treatment and prevention goals or sustain its progress over the next phase of this programme, said Asia Russell at Health GAP.
Forty million people around the world currently suffer from the disease; about two-thirds of them in sub-Saharan Africa. Some 4.3 million people were newly infected in 2006, according to the WHO, an increase of 400,000 from 2004.
UNAIDS estimates that more than 1.3 million people were receiving antiretroviral therapy in low- and middle-income countries by December 2005, up from approximately 400,000 people two years earlier.
Although the number of people in sub-Saharan Africa receiving treatment increased more than eight-fold between 2003 and 2005, it was still just over 800,000 at the end of 2005, while some 24.5 million people in the region are infected with HIV.
