Evaluating Bush's AIDS plan

I n all human history, there have been few events that affected humanity so profoundly as AIDS. Now, 20 years into the epidemic, it appears the U.S. may finally match the magnitude of its efforts to the severity of the problem. In his State of the Union address, President Bush launched the Global AIDS Initiative, pledging $15 billion over the next five years to turn the tide of the pandemic. The pledge is historic, and we must hope it comes to pass — but I, for one, am not holding my breath.

Cynics would point out that the Bush record on AIDS is suspect. After all, this is the same president who just last August rejected a $200 million payment on the U.S.' $500 million pledge to the Global Fund to Fight AIDS, Tuberculosis, and Malaria. After all, this is the same president who withheld funding from the United Nations Population Fund's (UNFPA) family planning and HIV/AIDS activities because UNFPA sponsors abortion programs abroad. After all, this is the same president who opposed inserting language about condom use into international AIDS education literature.

Cynics would also have plenty of reasons for the President's change of heart. Remember the canceled trip to Africa, and the need to mend bridges there? Is Bush just worried about the Democrats using AIDS as a presidential campaign issue in 2004? Does he need a humanitarian issue with few domestic and international political tradeoffs? Does he want to appease the Christian right, which has called for stepped-up AIDS efforts? Well, launching a global AIDS program accomplishes all this — and more. But these gripes are not fair. There are probably lots of reasons for Bush's decision to initiate the program — reasons that include his compassion for the 42 million people with HIV or AIDS around the world, as well as his heightened recognition that AIDS is an economic and security crisis in many parts of the world.

. So what does the new Global AIDS Initiative actually do? First, it is useful to know how the U.S. currently fights global AIDS. The bulk of the roughly $1 billion the U.S. now spends is channeled through the Agency for International Development, well known for its bureaucracy and the tough requirements it imposes on grant and loan recipients. Large sums also go to the Centers for Disease Control to help train foreign health professionals on AIDS-related matters; the National Institutes of Health for AIDS research; and small amounts also go to the Departments of Labor, Defense and Agriculture for their own AIDS projects. In addition, the United States contributes to the Global Fund, UNAIDS, the World Bank, and others. The Global AIDS Initiative is an entirely new bilateral (country-to-country) account that will target 14 countries, selected on grounds that are not entirely clear, and promises to dwarf current and past U.S. spending.

But there are some fuzzy numbers in the new proposal. A recent analysis by Lael Brainard of the Brookings Institution finds that "the Administration's claims of a $1 billion increase in FY04 and a $10 billion cumulative increase are relative to an unrealistically low baseline . . . A more realistic baseline suggests the net increase for fiscal 2004 is closer to $500 million, and the cumulative 5-year increase would be similarly reduced." In short, this analysis finds that while the Administration would provide significant budget increases for global poverty and HIV/AIDS, and deserves credit for its heightened responsiveness to these critical challenges, the budget proposals nonetheless fall short of the Administration's promises. Under the Bush Plan, spending would reach a maximum $3.86 billion only in 2008. Indeed, the bulk of the money will be spent in 2006-2008, far enough ahead in time for future congresses to hack it with the budget axe. More money is needed now, not in five years. Gradualism in fighting AIDS means death — something we should have learned long ago.

AIDS is a global problem that requires a global effort — but the Bush Plan essentially bypasses the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and so bypasses a multilateral approach to confronting AIDS. By sidestepping the Global Fund, President Bush foregoes a unique opportunity to leverage international support and implement a global strategy. The economist Jeffrey Sachs also points out the danger in the Bush Plan's endorsement of a "one-size-fits-all" approach to AIDS control — with the elaborate system of central hospitals and satellite clinics that the administration hopes will implement the Global AIDS Initiative. Country-specific and culture-specific programs are needed, something the Global Fund takes into account, but something the Bush Plan does not.

The world will never be able to remove fully the stain from its decades-long neglect of the global pandemic. But President Bush has given the United States and the world the opportunity to accept at last its responsibility to humanity to confront AIDS. Whatever its motivation, and however the numbers add up, the Bush Plan is a monumental call to action that holds extraordinary promise. And only time will tell if that promise is good.

Adam Frankel is a Wilson School major from New York, N.Y.