$15 billion AIDS bill signed, but full funding shaky

President George Bush signed landmark legislation authorising $15 billion to fight AIDS in Africa and the Caribbean, and now the spotlight switches to making sure Congress’ notoriously independent-minded appropriators actually come up with the money.

Bush signed the bill in a State Department ceremony, flanked by ambassadors from the 14 nations that are the focus of the AIDS effort. The bill calls for $3 billion a year over five years, almost tripling the amount of money the United States has spent to prevent and treat HIV and AIDS in those countries.

But getting the money during a federal budget crunch could be tough. “The devil is really in the details. Between the tax cuts and all the money being spent on terrorism, there’s little discretionary money left,” said Fred Dillon, policy director for the San Francisco-based Pangaea Global AIDS Foundation. “It will be extremely difficult.”

Bush, who has surprised and pleased AIDS activists with the commitment he has shown to combating the global pandemic since unveiling his initiative in his State of the Union address in January, didn’t specifically commit himself to a full appropriation in the expanded programme’s first year.

But he said, “We’ll provide unprecedented resources to the effort. And we will keep our commitment until we have turned the tide against AIDS.”

Some of Bush’s usual critics have already stepped forward to press him to force the Congress controlled by his fellow Republicans to come through with the full appropriation. The President originally proposed starting the programme slowly, at about $1.7 billion in the first year, then increasing the spending over five years. But Congress authorised $3 billion a year.

“I am tired of lofty rhetoric that makes people feel good but bears little resemblance to the administration’s actions,” Senator Patrick Leahy (Democrat, Vermont) said on the Senate floor last Friday. “The President should do what he says. He should do what he is asking others to do, and submit a budget amendment for the $3 billion authorised to fight AIDS.”

Representative Barbara Lee (Democrat, Oakland), who has been pushing for more AIDS funding for years, said, “I have to be cautiously optimistic. I think it would be morally wrong to move this bill and raise the hopes of millions who are dying of this pandemic and then not come through.”

Representative Dave Weldon (Republican, Florida), a physician who has treated AIDS patients and is a House Appropriations Committee member, said momentum was with the global AIDS bill’s backers.

“With the vote we had on this,” he said, referring to the bill’s overwhelming margin of passage, “it will be hard for us not to address the requirements of this legislation.”

Mark Isaac, vice president of the Elizabeth Glaser Paediatric AIDS Foundation, praised Bush’s commitment, but added, “We need to hold his feet and the Congress’ feet to the fire.”

Bill O’Keefe, director of government relations at Catholic Relief Services, which operates HIV-AIDS programmes in 31 foreign countries, said that with Republicans in charge in Washington, AIDS funding would be a test for Bush.

“With the House and Senate under Republican control, the administration will have an opportunity to demonstrate its commitment,” O’Keefe said. “We hope the President’s will and commitment will be brought to bear.”

The President said the legislation would prevent seven million infections, care for 10 million people with HIV and AIDS orphans and give anti-retroviral therapy to two million. The bill recommends that 55% of the money go to treatment, 20% to prevention, 15% to palliative care and 10% for orphans.