In a key victory for President George W. Bush and anti-AIDS activists, the U.S. House of Representatives Thursday approved a five-year, $15 billion package to fight HIV/AIDS in 14 African and Caribbean nations. The bill, which would provide $3 billion each year beginning in 2004 to some of the world’s worst-affected countries, provides that up to $1 billion in each annual installment should go the cash-strapped Global Fund to Fight AIDS, TB, and Malaria.

That was five times the amount that Bush originally proposed for the Global Fund when he first requested the $15 billion package in his State of the Union address late last January. Bush, however, went along with the higher amount for the Fund, which is chaired by his Health and Human Services Secretary, Tommy Thompson, after lobbying by the right-wing chairman of the House International Relations Committee, Henry Hyde, who crafted the final version of the bill.

While claiming a significant victory in Thursday’s vote, activists cautioned against early celebration, stressing that the money contained in the bill still faces a number of obstacles before it can actually be disbursed, even if, as expected, the Senate passes the same or a similar version as early as next week. That’s because the bill passed Thursday merely “authorizes” the money. For the funds actually to be spent, they must be included in a separate appropriations bill, which is likely to be taken up later this year.

“Similar (authorization) bills have been ignored in the past, even when approved by the full House,” said Paul Zeitz, director of the Global AIDS Alliance. “The real test of the president’s commitment will be whether he works hard to persuade members of the Appropriations Committees to turn these funding levels into a reality,” Zeitz added.

More Broken Promises?

The point was echoed by Salih Booker, director of Africa Action, a grassroots group that has lobbied for Washington to provide as much as $3.5 billion annually to the Global Fund, a multilateral agency established to better coordinate funding for anti-AIDS projects around the world. “This is just the authorization,” he said, “so it’s an easy vote. The question is whether Congress is prepared to break the budget limits and really appropriate the money.” Still, activists, including Booker, conceded that the House bill is a far better product than what Bush had originally proposed in January.

In addition to providing only $200 million a year to the Global Fund, Bush’s original proposal also called for starting disbursements much more slowly over the five-year period, with only $1.6 billion to be spent in fiscal 2004, which begins October 1. The administration also considered placing anti-abortion-related conditions on the money that would have made it far more difficult for grassroots groups to become a recipient. But Hyde, a long-time anti-abortion leader himself, helped persuade Bush and a number of right-wing Republicans that tough curbs on spending the money would alienate Democrats, and that, to ensure strong bipartisan support, both sides would have to compromise on the final bill.

Bush, who intends to travel to Africa later this year, went along in spite of opposition from some Christian Right leaders, who objected to providing money for encouraging the use of condoms to prevent transmission of HIV and to the lack of U.S. control over the Global Fund’s funding policies. “The bill, in its present form, would throw taxpayer money at condom handout schemes in Africa,” said Ken Conner, director of the right-wing Family Research Council (FRC) earlier this week. “By signaling that President Bush will sign the bill ‘as is,’ the White House probably has made it much more difficult to pass amendments which would focus U.S. efforts on abstinence and monogamy, or which would limit funding to the UN’s disastrous Global AIDS Fund and other anti-family organizations.”

But Bush, while indicating sympathy with concerns like Conner’s, bowed to Hyde. “Time is not on our side,” he declared Tuesday at a White House ceremony that included 13 ambassadors from sub-Saharan Africa where AIDS has hit hardest, claiming more than 5,000 lives in the region each day. “So I ask Congress to move forward with the speed this crisis requires.”

In the end, Hyde himself went along with two right-wing amendments to the package regarding the bill’s endorsement of the so-called “ABC” strategy (abstinence, being faithful, and condoms) prevention strategy. One permits funding to go to religious groups that do not provide information about condoms out of “moral or religious objection.” The other requires that one third of all the money in the bill targeted at prevention be used to encourage abstinence in sexual relations. Some groups strongly objected to these amendments, suggesting that they would discourage the use of condoms. “A lopsided emphasis on abstinence is irresponsible,” said Sally Ethelston of Population Action International. “Efforts to prioritize the ‘A’ or ‘B’ to the exclusion of the ‘C’ will only make condoms less accessible to those who need them most.”

Will Resources Match the Rhetoric?

Overall, however, anti-AIDS groups said they were pleased about the House’s strong approval of the bill. “This is a remarkable and historic day in the fight against AIDS,” said Nils Daulaire, president of the Global Health Council (GHC). “The United States is now showing its global leadership on this issue.”

Activists are hoping that, if the money is actually appropriated, it will significantly boost the Global Fund, which is designed to act swiftly on funding proposals and reduce the administrative burden on recipients caused by the reporting requirements of multiple donors. The Fund’s management has estimated that it will need at least $7 billion over the next two years just to keep pace with demand.

Booker said Thursday after the vote that his group and others will still push for more U.S. contributions to the Fund, as well as other measures that would strengthen the ability of African governments to contain the disease. “Africa’s illegitimate debts should be canceled, enabling governments to spend money on health care instead of debt repayments,” he said. “And the White House must break with the pharmaceutical industry and support African countries’ access to cheaper, generic anti-retroviral drugs.” In addition, he said, Bush’s own remarks about the urgent nature of the disease should justify providing more money already in this fiscal year to the Global Fund and the anti-AIDS fight. “After all, the Bush administration secured $79 billion in a supplemental (appropriation) for war in Iraq.”

He cited Powell’s interview in this week’s edition of U.S. News and World Report in which Powell said, “The greatest weapon of mass destruction today on the face of the Earth is HIV, and it is a destroyer of people, families, nations, societies, and hopes in the poorest parts of the world, and it is spreading.” “The White House is still failing to match rhetoric with resources,” Booker said.

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