Bush Pledges $1.2 Billion For Africa to Fight Malaria

The bulk of the aid announced yesterday, $1.2 billion, is aimed at fighting malaria, with a target of cutting in half the death toll of a disease that annually kills more than 1 million Africans, hitting children hardest. Bush also repeated his vow to double total assistance to Africa by 2010.

"We seek progress in Africa and throughout the developing world because conscience demands it," Bush said in a speech previewing the summit in Scotland of the Group of Eight major industrialized nations. "Americans believe that human rights and the worth of human lives are not determined by race or nationality, or determined by distance. We believe that every life matters and every person counts."

The president's announcement, coupled with previous commitments of new food aid and debt elimination for African nations, will enable him to head to Scotland saying that he is stepping forward to help, even though he will not meet the far more ambitious goals set by British Prime Minister Tony Blair, his friend and summit host. Bush's speech and initiatives drew praise from advocates who have not always embraced him, including rock singer Bono, perhaps the world's most prominent celebrity to promote aid.

At the same time, however, some analysts and advocates said the president's lofty language was not fully supported by his numbers, which they said were reached in part by repackaging previous pledges. Some pointed out that even Bush's fresh dedication to combating malaria contrasted with his own cuts to U.S. infectious-disease programs just a few months ago.

(Emphasis added.)


In related news:

Mr. Bush and Africa

The Bush administration promises at least $1.2 billion over five years for its initiative. Success isn't assured: Health programs in Africa often falter for lack of nurses and doctors, and the best malaria medicines, which are based on plant extracts, are in short supply. But the possibility that malaria may be controlled for as little as $20 million or so per country per year illustrates the potential bargains in development.

While the sticker price for this initiative is small, the commitment implied from Mr. Bush is even smaller. The president's budget request for 2006 actually cut malaria funding; he will be able to afford the first year of his new program only because Congress insisted on boosting the number. The money required in the next couple of years is modest, because the program's cost comes mainly in 2009 and 2010, and Mr. Bush may try to pay for his promise by skimping on U.S. payments to the Global Fund for AIDS, Tuberculosis and Malaria -- a possibility that development campaigners will rightly be watching for.

(Emphasis added.)


Botswana's Gains Against AIDS Put U.S. Claims to Test

As global leaders gathered in Davos, Switzerland, for the World Economic Forum in January, officials from President Bush's $15 billion anti-AIDS program issued a news release citing their accomplishments. Nowhere were the numbers more impressive than in Botswana, where 32,839 AIDS patients were receiving life-extending treatment with the help of the U.S. government, they said.

But thousands of miles away in Botswana, the Bush administration's claim provoked frustration and anger among public and private partners that had built Africa's most far-reaching AIDS treatment program, recalled those involved. Although the Bush program had promised millions of dollars of support, no money had yet arrived, they said.

(Emphasis added.)

An Epidemic Failure
Whatever happened to Bush's pledge to combat AIDS in Africa?

washingtonpost.com
Bush Pledges $1.2 Billion For Africa to Fight Malaria
President Also Vows to Double Total Aid to Continent by 2010
By Peter Baker
Washington Post Staff Writer
Friday, July 1, 2005; A01

President Bush announced a $1.7 billion aid package for Africa devoted primarily to combating malaria, unveiling the initiatives yesterday in advance of an international summit next week dedicated to breaking the continent's perpetual cycle of poverty, disease and famine.

Calling on the world to move beyond "empty symbolism and discredited policies," Bush pledged that the United States will join other rich nations to help the poorest -- a rhetorical and financial commitment that surprised some advocacy groups, which had complained in recent weeks that he was not doing enough.

The bulk of the aid announced yesterday, $1.2 billion, is aimed at fighting malaria, with a target of cutting in half the death toll of a disease that annually kills more than 1 million Africans, hitting children hardest. Bush also repeated his vow to double total assistance to Africa by 2010.

"We seek progress in Africa and throughout the developing world because conscience demands it," Bush said in a speech previewing the summit in Scotland of the Group of Eight major industrialized nations. "Americans believe that human rights and the worth of human lives are not determined by race or nationality, or determined by distance. We believe that every life matters and every person counts."

The president's announcement, coupled with previous commitments of new food aid and debt elimination for African nations, will enable him to head to Scotland saying that he is stepping forward to help, even though he will not meet the far more ambitious goals set by British Prime Minister Tony Blair, his friend and summit host. Bush's speech and initiatives drew praise from advocates who have not always embraced him, including rock singer Bono, perhaps the world's most prominent celebrity to promote aid.

At the same time, however, some analysts and advocates said the president's lofty language was not fully supported by his numbers, which they said were reached in part by repackaging previous pledges. Some pointed out that even Bush's fresh dedication to combating malaria contrasted with his own cuts to U.S. infectious-disease programs just a few months ago.

"This was a good-news, bad-news speech today," said Susan E. Rice, who was assistant secretary of state for Africa under President Bill Clinton. Bush's address "touched on all the right levers for enhancing development," said Rice, who was a top foreign policy adviser to Democratic presidential nominee John F. Kerry in 2004. "The bad news is when you look at the numbers . . . it's a whole lot of smoke and mirrors, and it's frankly misrepresenting where we are and misleading about where we're going."

David Beckmann, president of Bread for the World, was more supportive, calling Bush's move a powerful boost to a summit that could bring historic change to Africa. The Scotland gathering promises to be "an extraordinary convergence, and so it's important that President Bush provides leadership at this moment because this time isn't going to come again," Beckmann said in an interview. "From what he said this morning, I wouldn't say this is great leadership, but it is a real partnership in the global effort to reduce poverty in Africa."

Blair has devoted the G-8 summit to forging a lasting accord to transform Africa, and he has traveled from capital to capital seeking support for a plan that would double annual international aid to $50 billion by 2010 and triple it by 2015. He wants the world's donor nations to commit to spending 0.7 percent of their gross national products on development assistance and has won an agreement to cancel $40 billion in debt owed by poor nations.

While Bush went along with the debt elimination plan, he has refused to meet Blair's broader aid target, with the United States spending less than 0.2 percent of its gross national product on foreign development aid. Bush has argued that his administration has already moved aggressively to help Africa fight famine, AIDS and other problems.

When Blair visited Washington last month, Bush announced $674 million in food aid. In yesterday's speech, he announced three initiatives -- $1.2 billion over five years to fight malaria, $400 million over four years to improve education, and $55 million for programs to combat sexual abuse and violence against women.

The centerpiece malaria proposal -- which requires congressional approval -- would tackle a disease that ravages the continent, despite being preventable and treatable if addressed promptly. The program would provide indoor spraying, long-lasting insecticide-treated nets and new combination drugs for treatment, Bush said, starting in Tanzania, Uganda and Angola and eventually including at least 15 other countries.

The World Health Organization, UNICEF and the Bill & Melinda Gates Foundation all hailed Bush's program, with UNICEF calling it "a great step forward for child health and survival." At the same time, the Global AIDS Alliance, another advocacy group, noted that in the short term, the malaria money would merely replenish funding Bush cut in the current year's budget.

According to the group, the budget Bush submitted to Congress earlier this year cut spending for infectious diseases by $45 million. The malaria program Bush announced yesterday would earmark $30 million more for next year, less than the original cut, before ramping up to $500 million in 2010.

Advocates say the United States has not fully funded its new Millennium Challenge aid program or AIDS prevention in Africa, and they took issue with Bush's claim to have already tripled aid to Africa during his presidency and his promise to double it again by 2010. National security adviser Stephen J. Hadley said the Bush administration now spends $4.3 billion a year on Africa and would increase that to $8.6 billion in five years.

Others said the dollar debate should not obscure the importance of Bush's interest in helping Africa. "We'll fight about the numbers, because of the need for even more children in school, even more malaria protection, but there's no denying the commitment here," Bono said in a statement. "This was a great speech by a man who means to understand the challenges in Africa and America's opportunity to help solve them as partners."

Staff writer David Brown contributed to this report.
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Mr. Bush and Africa
Post
Friday, July 1, 2005; A24

THREE YEARS AGO, the pressure of a looming international aid summit induced President Bush to launch the Millennium Challenge Account, an instrument for plowing generous aid into poor countries with uncorrupt institutions and good policies. Yesterday Mr. Bush responded to similar pressure ahead of next week's Group of Eight summit, which will have Africa high on the agenda. But whereas the Millennium Challenge initiative involved a promise of $5 billion extra for development per year, Mr. Bush's initiatives this time around are modest.

The most significant new effort announced yesterday was for malaria, a disease that kills about a million African children annually. Borrowing an idea from the Bill and Melinda Gates Foundation, which announced a plan last month to cut malaria deaths by 70 percent in Zambia, the administration proposes to finance similar efforts in three other African countries this year, six more next year and another six the year after. The idea is to identify and then plug gaps in a country's battle against the disease: Does everyone have access to bed nets? Is there a systematic use of insecticide to control mosquitoes? Are pregnant women getting preventive doses of malaria medicine? The Bush administration promises at least $1.2 billion over five years for its initiative. Success isn't assured: Health programs in Africa often falter for lack of nurses and doctors, and the best malaria medicines, which are based on plant extracts, are in short supply. But the possibility that malaria may be controlled for as little as $20 million or so per country per year illustrates the potential bargains in development.

While the sticker price for this initiative

is small, the commitment implied from Mr. Bush is even smaller. The president's budget request for 2006 actually cut malaria funding; he will be able to afford the first year of his new program only because Congress insisted on boosting the number. The money required in the next couple of years is modest, because the program's cost comes mainly in 2009 and 2010, and Mr. Bush may try to pay for his promise by skimping on U.S. payments to the Global Fund for AIDS, Tuberculosis and Malaria -- a possibility that development campaigners will rightly be watching for. Meanwhile, Mr. Bush promises to spend an extra $100 million a year on education in Africa and a token $55 million for women's empowerment.

This is small potatoes next to the $6 billion in extra aid that Mr. Bush should have pledged if he had wanted the United States to deliver its share of the $25 billion boost that is next week's G-8 target. It is also insignificant relative to the doubling of U.S. assistance to Africa that Mr. Bush called for yesterday. Achieving that doubling is going to depend not on yesterday's new programs but on realizing the pledges of his first term. The president's HIV-AIDS initiative, announced in 2003, aims to dispense $15 billion over five years and is firmly on track. But Congress's appropriations for the Millennium Challenge Account, which was supposed to be $5 billion per year, were only $1.5 billion in the current fiscal year.

In his speech yesterday, Mr. Bush rightly said that aid alone is not the key to Africa's progress: trade liberalization, military support for peacekeeping and the quality of African leadership are at least as important. But aid remains a useful tool, and the United States ought to do more for the world's poorest continent.

© 2005 The Washington Post Company
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Botswana's Gains Against AIDS Put U.S. Claims to Test
By Craig Timberg
Washington Post Foreign Service
Friday, July 1, 2005; A01

GABORONE, Botswana -- As global leaders gathered in Davos, Switzerland, for the World Economic Forum in January, officials from President Bush's $15 billion anti-AIDS program issued a news release citing their accomplishments. Nowhere were the numbers more impressive than in Botswana, where 32,839 AIDS patients were receiving life-extending treatment with the help of the U.S. government, they said.

But thousands of miles away in Botswana, the Bush administration's claim provoked frustration and anger among public and private partners that had built Africa's most far-reaching AIDS treatment program, recalled those involved. Although the Bush program had promised millions of dollars of support, no money had yet arrived, they said.

The operations manager of Botswana's treatment program, Segolame Ramotlhwa, called the U.S. figures "a gross misrepresentation of the facts." His boss, Patson Mazonde, who as deputy permanent secretary for health services had overseen the program since its inception in 2002, called the Bush claim "false" but suggested it was merely a mistake.

They agreed on the number of patients in Botswana who had been put on treatment because of the Bush program: zero.

After first defending its figures from the January news release, the Bush administration last month revised them sharply downward. But even the revised numbers remain in dispute. Administration officials announced that 20,000 people in Botswana were receiving "significant support" from U.S. programs for their AIDS treatment. Health officials in Botswana maintained, as they have for months, that no citizen was dependent on U.S. support for treatment, the cost of which has been covered overwhelmingly by the Botswanan government.

The disagreement underscores not only the highly politicized nature of treating AIDS in Africa, where less than 10 percent of the people who need antiretroviral drugs are getting them, but also how rare -- and coveted -- success stories such as those in Botswana remain.

To people receiving the lifesaving medications, the question of who gets the credit may not matter. But for the government of Botswana, the groundbreaking AIDS program is a source of enormous national pride, while for the Bush administration, being able to announce such successes bolsters its claim to having begun to "turn the tide" against AIDS in the developing world.

The dispute essentially comes down to a question of how to define "support." In March, in an annual report on the program, the Bush administration said support could include general "system strengthening" -- a category so broad that it could allow officials to claim to have supported treatment of any AIDS patient who benefited, however indirectly, from U.S. government assistance.

The head of the Bush administration's program in Botswana, Peter H. Kilmarx, from the Centers for Disease Control and Prevention in Atlanta, said in an interview here in May that he was aware of the upset among the Botswanan officials but that the treatment claims fit within U.S. government guidelines. The definition used for measuring support, he said, had broadened to the point that even assistance as trivial as editing a government health official's speeches could allow the Bush program to say it had supported treatment for everyone receiving antiretrovirals from that nation's public health system.

The system "could be abused," Kilmarx said. "But it's not."

The Bush program set its numerical targets even before the legislation creating the program was drafted. In his 2003 State of the Union address, Bush stunned AIDS activists by announcing a $15 billion commitment over five years to fight the disease. The program would soon become what U.S. officials call the largest global health initiative undertaken against a single disease by a single country.

Bush announced that the program would "treat at least 2 million people with life-extending drugs." But over the next year, as administration officials developed the president's promise into a program, they recast the goal. It was not practical, officials say they concluded, for the U.S. government to build clinics, hire doctors and hand out drugs all over the developing world. And officials from the countries targeted for the assistance, including Botswana, made clear that while they wanted help, they believed that their own governments, not the United States, should be distributing the medicine.

In Botswana, a landlocked nation of 1.6 million people in southern Africa, officials were tackling one the world's worst AIDS epidemics. Nearly four of every 10 working-age adults were infected with HIV, the virus that causes the disease. Bolstered by vast diamond wealth and a stable government, President Festus Mogae had committed the nation to providing costly, state-of-the-art AIDS treatment to every citizen.

The daring promise, the first of its kind in Africa, attracted tens of millions of dollars in support from donors, including substantial amounts from the U.S. government, which took the lead in upgrading laboratories and building a network of centers to test patients for HIV.

With the inception of the Bush program, both the White House and Congress began focusing on delivering the antiretroviral drugs that alone had the prospect of saving millions of lives. And the U.S. officials charged with implementing this vision were also supposed to produce quantifiable results to make explicit the value of the $15 billion investment.

In Botswana at least, deciding who deserved credit for any one person getting the drugs proved complicated.

Harriet M. Isaacs, a 59-year-old civil servant with AIDS, started taking antiretrovirals in 2002, the year before Bush announced his program. The drugs have restored her to health, and with a few months left until her planned retirement, she now looks forward to many more years of playing with her grandchildren.

She expresses no doubt about who saved her life: the government of Botswana.

"It's very expensive," Isaacs said while seated in a bustling AIDS clinic here, "but it's helping people. . . . I'm confident that I can go up to 100 [years old] now."

The reality of who paid for her health care is more complex. She visits a clinic built with the help of the Bill & Melinda Gates Foundation. She takes medicine donated, in part, by the American pharmaceutical giant Merck. And the cost of most everything else -- doctors, nurses, lab work -- is covered by the government of Botswana.

For Isaacs, the role played by the Bush program -- so far, at least -- has been minor, confined mainly to the training of medical personnel and the monitoring and evaluation of the existing government program. The total outlay of U.S. government funds for "treatment" in Botswana last year was $2.5 million, about one-twentieth of the amount paid by the Botswana government. And even that money was delayed by many months.

Yet when it came time to tabulate the Bush program's successes in Botswana, every patient receiving antiretroviral drugs from the national program, including Isaacs, was included. U.S. officials also counted several thousand others who were receiving their medicine from private doctors because, Kilmarx said, some had benefited from a U.S.-funded training program.

He explained that since the January news release in Davos, the number of AIDS patients for which the Bush administration was claiming credit had continued to grow. That day, he said, he was submitting a new total of 41,444 in Botswana to top program officials in Washington. Everyone in Botswana receiving antiretroviral drugs was included, Kilmarx said.

In the days that followed, Kilmarx was asked about the comments made by Mazonde, Ramotlhwa and other health officials from Botswana. He defended the program and then called another meeting with them. Later on the day of that meeting, he reiterated his defense of the numbers, saying that Mazonde and Ramotlhwa were "entirely comfortable" with how the Bush program had portrayed its role in Botswana.

The message he received from the health officials, Kilmarx said, was that while they had been unhappy with some of the Bush program's characterizations, they wanted the funding to keep coming.

In subsequent phone interviews, both Mazonde and Ramotlhwa softened their tone, emphasizing their gratitude for the millions of dollars that, they said, they still expected from the Bush program. Ramotlhwa suggested it was better to say the Bush numbers exhibited "some element of distortion" rather than characterizing them as "a gross misrepresentation of the facts."

Yet when asked if there was anyone whose antiretroviral treatment was dependent on the Bush program, Ramotlhwa and Mazonde said they knew of none.

"We cannot single out a person who would not be receiving treatment," Mazonde said.

On June 13 -- two weeks after that interview -- Bush announced new totals for his AIDS program. They were ahead of schedule, reaching more than 200,000 people with U.S.-supported treatment in the 15 developing countries the program focused on.

In backup documents distributed by U.S. officials, the treatment total for Botswana was neither the 32,839 cited in January nor the 41,444 that Kilmarx submitted to his superiors in May. The new total, offered with no explanation, was 20,000.

Asked about the shift, the Bush program's deputy coordinator, Mark R. Dybul, said in an interview at his Washington office that reporting systems were evolving. "We're changing the numbers as we refine reporting," Dybul said. Of the Botswana health officials, Dybul added, "They saw what's in here and they cleared it."

He also disputed Kilmarx's statement that minor assistance, such as revising an official's speech, would allow the Bush program to claim it had supported treatment for everyone receiving it in a country. The new totals, Dybul said, included only those receiving "significant support," meaning that "these people would not have quality treatment, would not have substantial services, without the U.S. government."

In a final phone interview, Mazonde again expressed gratitude for the U.S. aid. He added that a series of conversations with U.S. officials in recent weeks had impressed on him the many ways that the Bush program funding was assisting Botswana, and that several million dollars promised for the national treatment program would soon be available.

But when pressed, Mazonde said there were not 20,000 people in Botswana whose "quality treatment" was dependent on the U.S. government. In fact, he said, there were none.

© 2005 The Washington Post Company
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An Epidemic Failure
Whatever happened to Bush's pledge to combat AIDS in Africa?
By GERALDINE SEALEY

When President Bush introduced his global AIDS initiative in January 2003 -- calling it "a work of mercy beyond all current international efforts" -- the plan certainly sounded promising. Bush pledged to spend $15 billion over five years to provide life-saving drugs to at least 2 million people with HIV, prevent 7 million new infections, and care for the sick and orphaned in fifteen countries. Most of the money, the president declared, would go to sub-Saharan Africa, home to the majority of the world's 40 million people living with HIV and AIDS. In the hardest-hit countries, nearly forty percent of the population is infected, and 12 million children across the region have lost at least one parent to the disease. "I believe God has called us into action," Bush declared during a trip to Uganda in 2003. "We are a great nation, we're a wealthy nation. We have a responsibility to help a neighbor in need, a brother and sister in crisis."

Dubbed the President's Emergency Plan for AIDS Relief (PEPFAR), the ambitious agenda provided the administration with some much-needed PR at the very moment it was preparing to defy international will by invading Iraq. But from the start, Bush has failed to deliver on the funding he promised -- and what little money he has provided is being used to promote a right-wing agenda that undercuts international efforts and puts millions of people in AIDS-ravaged countries at greater risk of infection and death.

Thanks to the president's foot-dragging, his "emergency plan" took its sweet time getting going. Bush requested only $2 billion for PEPFAR in its first year -- a billion less than one would expect. Then, when Congress decided to approve $400 million more than the president asked for, Bush unsuccessfully fought to block the increase. By the time the first relief funds arrived in Africa, nearly a year and a half had passed since the president announced his plan -- a costly delay in fighting an epidemic that claims 8,500 lives every day.

The administration insists it will meet its goal by 2008, saying it planned all along to gradually "ramp up" the program. But public-health experts say it looks increasingly unlikely that Bush will fulfill his promise -- and that even if he does, the money will fall far short of what is needed. According to UNAIDS, a partnership involving the World Bank and nine other international aid groups, the world needs to spend $20 billion a year by 2007 to wage an effective war against AIDS. What Bush proposes to spend annually, if funding remains constant, is less than half the $6.6 billion that America would be expected to contribute based on the size of its economy. "The fact that the United States can spend $300 billion on the wars in Iraq and Afghanistan but cannot find a relative pittance to rescue the human condition in Africa -- there is something profoundly out of whack about that," says Stephen Lewis, the secretary-general's special envoy for HIV/AIDS in Africa.

The president's AIDS initiative, like his invasion of Iraq, is a go-it-alone affair that ignores the clear global consensus on how to fight AIDS. In launching his own initiative, Bush has shifted the bulk of U.S. money away from the Global Fund to Fight AIDS, Tuberculosis and Malaria, an international organization that has funded projects in 128 countries and is widely recognized as the best way to distribute AIDS funds. "Bush is starving the fund," says Dr. Paul Zeitz, executive director of the Global AIDS Alliance. "It's despicable, frankly."

In addition to shortchanging international relief efforts, Bush is using AIDS funds to place religion over science, promoting abstinence and monogamy over more effective measures such as condoms and sex education. Before overseas groups can receive U.S. funding, for example, the Bush administration requires them to take a "loyalty oath" to condemn prostitution -- a provision that AIDS workers say further stigmatizes a population in need of HIV education and treatment. Brazil recently became the first country to rebel against the oath, announcing in May that it was rejecting $40 million in AIDS grants from the administration. "What we're doing is imposing a really misguided and ill-informed ideology on top of a public-health crisis," says Jodi Jacobson, executive director of the Center for Health and Gender Equity in Takoma Park, Maryland.

Bush's plan calls for an "ABC" approach to HIV prevention -- which stands for abstinence, "be faithful" and condom use -- but the administration is stressing the "A." In its first year, PEPFAR spent more than half of the $92 million earmarked to prevent sexual transmission on promoting abstinence programs. Studies show that such programs actually increase risk by discouraging contraceptive use. What's more, focusing on abstinence and monogamy ignores the reality facing young women and girls in Africa and other impoverished regions, who are often infected by wandering husbands or forced to have sex in exchange for food or shelter. Among fifteen- to twenty-four-year-olds in sub-Saharan Africa, studies show, more than three times as many young women are infected with HIV as young men.

"It's only a matter of time before the impact of abstinence-only programs can be measured in needless new HIV infections," says Jonathan Cohen, an HIV/AIDS researcher with Human Rights Watch.

The emphasis on morality is being driven by social conservatives, who have made spreading the gospel of abstinence and monogamy to Africans their primary mission. "Condoms promote promiscuity," says Derek Gordon of the evangelical Christian group Focus on the Family. "When you give a teen a condom, it gives them a license to go out and have sex." At a congressional hearing in April, Rep. Henry Hyde threatened to cut funding for organizations that promote condoms. "The best defense for preventing HIV transmission is practicing abstinence and being mutually faithful to a non-infected partner," Hyde declared.

Nowhere is the effort by conservative Republicans to turn back the clock on sex education more pronounced than in Uganda. By aggressively promoting condom use and sex education, Uganda has managed to cut its HIV rate from fifteen percent of the population to barely six percent during the past decade, making it Africa's biggest success story. But under pressure from the Bush administration, Uganda has taken a dangerous turn toward an abstinence-only approach. In April, the country's Ministry of Education banned the promotion and distribution of condoms in public schools. To make matters worse, the government has even engineered a nationwide shortage of condoms, issuing a recall of all state-supplied condoms and impounding boxes of condoms imported from other countries at the airport, claiming they need to be tested for quality control. As of this year, a top health official announced, the government will "be less involved in condom importation but more involved in awareness campaigns: abstinence and behavior change."

The Bush administration is supporting the shift by pumping $10 million into abstinence-only programs in Uganda. "One can put a dollar figure on the political pressure," says Cohen, who has closely studied the initiatives in Uganda. "Groups know the more they talk about abstinence, the more they'll get U.S. funding. And they fear that if they talk about condoms they'll lose funding -- or, worse, get kicked out of the country."

Ambassador Randall Tobias, who serves as Bush's global AIDS czar, issued written guidelines in January that spell out the administration's agenda. Groups that receive U.S. funding, Tobias warned, should not target youth with messages that present abstinence and condoms as "equally viable, alternative choices." Zeitz of Global AIDS Alliance has dubbed the document "Vomitus Maximus." He says, "I get physically ill when I read it. It has the biggest influence over how people are acting in the field." And under a proposal being pushed by Republicans on Capitol Hill, Tobias would be given the power to divert even more money toward promoting abstinence. "All Republicans can think about is making Africans abstinent and monogamous," says a Democratic staffer involved in the negotiations. "It's the crassest form of international social engineering you could imagine."

The anti-condom order issued by Tobias is already having a chilling effect among the groups most effective at combating AIDS. Population Services International, a major U.S. contractor with years of experience in HIV prevention, says it can no longer promote condoms to youth in Uganda, Zambia and Namibia because of PEPFAR rules. "That's worrisome," says PSI spokesman David Olson. "The evidence shows they're having sex. You can disapprove of that, but you can't deny it's happening."

What's more, conservatives are attacking PSI for promoting condoms -- a campaign that prevented an estimated 800,000 cases of HIV last year. Focus on the Family recently denounced PSI as a "shady" and "sordid" organization that is leading Africans into immorality by promoting condoms. And in April, conservative Republicans in the House invited Martin Ssempa, a Ugandan minister, to Capitol Hill, to berate PSI and other public-health groups for "promoting promiscuity and condoms" in his country. This year, for the first time, U.S. funding for PSI has been reduced.

Groups that support the president's religious agenda, meanwhile, are beginning to receive money that has traditionally been devoted to more experienced organizations. The Children's AIDS Fund, a well-connected conservative organization, received roughly $10 million last fall to promote abstinence-only programs overseas -- even though the group was deemed "not suitable for funding" by an expert review panel. FreshMinistries, a Florida organization with little experience in tackling AIDS, also received $10 million. "Bush has enacted policies that will redirect millions of dollars away from groups that have experience fighting HIV and AIDS and toward groups that don't but are members of his religious constituency," says Cohen.

In the end, say public-health experts, the administration's diversion of funds away from tried-and-true HIV prevention methods is more than a misguided experiment -- it's a deadly game of Russian roulette that could mark a calamitous turn in Africa's attempts to get a handle on the AIDS epidemic. As Bush fails to make good on his promises, Africans continue to contract HIV and die from AIDS in the same numbers as they did during the worst phases of the epidemic.

"People will look back and say, 'Why didn't they stop the dying?' " says Zeitz. "Why don't we show our compassionate selves? What kind of country are we?"

(Posted Jun 02, 2005)
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