Advocates Upbeat on Bush Plan

President’s plan to increase spending on Africa draws cautious praise

A Bush administration proposal to spend $15 billion over five years fighting AIDS in parts of Africa and the Caribbean is drawing qualified praise from U.S. AIDS activists. “We welcome the new rhetoric and the new money,” said Sharonann Lynch, spokesperson for the Health Global Access Project (GAP), a group that advocates for AIDS treatments in developing countries. “Part of the work now for activists is to insure that the rhetoric turns into meaningful policy changes that will affect the lives of people with AIDS in poor countries.” The Bush proposal, announced in the State of the Union address on January 27, includes $10 billion in new spending. The effort, dubbed the Emergency Plan for AIDS Relief, would start in the next fiscal year with a $2 billion allocation. The money would be spent on AIDS drugs as well as prevention programs in Botswana, Cote d’Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, and Zambia, according to the White House web site. The plan also includes a $1 billion donation to a United Nations fund that battles AIDS, malaria, and tuberculosis around the globe. Kofi A. Annan, the U.N. secretary general, has said the U.S. contribution to that fund should be $2.5 billion annually. The president’s proposal did not make clear whether the $1 billion was a lump sum payment or the total for the next five years. Lynch said the demand for treatment and prevention programs is already so great that the new cash, while welcome, will not satisfy it. Activists will want the money spent as quickly as possible. “There is enough need out there and enough capacity to absorb much much more money,” Lynch said. “Why wait? People have been waiting long enough for the government to take real steps.” Activists will very quickly get an answer to at least some of their questions. The Bush administration will deliver a proposed budget to Congress for the 2004 fiscal year in the first week of February. “There are lots of questions,” said David E. Munar, associate director at the AIDS Foundation of Chicago. “We expect some of the answers will be contained in the White House budget request for ‘04 that is coming to Congress.” At first blush, however, Munar praised the proposal. “We think it’s significant and we applaud the president for including this in the State of the Union address,” he said. “It’s the largest financial commitment to AIDS relief ever made by a U.S. president.” But the Bush plan was faulted for the donation to the U.N. fund. “The global fund is recognized as the best vehicle we have now to fund resources to poor countries,” said Ronald Johnson, associate executive director of the Gay Men’s Health Crisis, or GMHC. “The $1 billion that he enunciated still falls way short of what is needed.” Activists also said the Bush plan fell short on responding to the domestic AIDS crisis. “Whether the White House has the same commitment to the domestic AIDS crisis that it has to the global AIDS crisis is a question,” Munar said. “This administration essentially flat-funded AIDS programs for two years and we are concerned about AIDS funding keeping pace with the epidemic domestically.” GMHC’s Johnson agreed, saying that Bush’s failure to discuss AIDS in America undercut his commitment. “It is very unfortunate that while he recognized the global crisis he devoted only one sentence to the domestic crisis,” he said. “That is not leadership, that is not responding to this epidemic. In our view it detracts from the statements he made on this crisis. Mr. Bush has serious responsibilities here at home that, to date, he has neglected.” Bush raised another possibly thorny issue in his speech. The president noted that the cost of AIDS drugs for one person had gone from $12,000 a year to just $300 a year. That lower figure is an apparent reference to the price charged for a three-drug regimen by Cipla, a company in India that manufactures generic versions of patented anti-HIV drugs. Beginning in the Clinton administration, the U.S. has supported pharmaceutical companies as they tried to restrict the ability of poorer nations to import those generic drugs. Activists are wondering if the comment represents a change in U.S. trade policy on this issue. “The $300 presupposes a generic drug and it remains to be seen if that was a speechwriter’s injection or if it’s a precursor of some significant policy changes on the availability of generic drugs,” Johnson said. “This administration appears to have come to the realization that generic drugs have to be a part of this effort.” Health GAP’s Lynch said her group hopes that U.S. trade policies will change.