Global Policy Forum

By Paul S. Zeitz

President George W. Bush's pledge to increase spending on the fight against AIDS by $10 billion over the next five years is encouraging, even historic. The president's budget, however, falls far short of what is needed to save millions of lives in the coming year, and it fails to make use of the most efficient way to distribute the money.

Only about 5 percent of the new spending is requested in the president's budget. Even more troubling, the president's budget cuts nearly in half the level of financing Congress authorized for the Global Fund to Fight AIDS, Tuberculosis and Malaria, a public-private partnership intended to expand effective programs. To finance the proposal, his budget also proposes cuts in children's health programs.

The AIDS pandemic will not wait for us to act. Some 13,000 new infections occur daily, 2,000 of them in children under 15 years old, while 8,500 people die of AIDS each day. In Africa, AIDS has devastated the work force, contributing to famine and reversing economic progress. By 2010, there will be 20 million AIDS orphans in Africa alone.

The longer the United States delays in providing the money it has promised, the more difficult and costly it will be to achieve results. Yet from my experience working for U.S. government agencies in Zambia, I know how long it can take for funds to move through the bureaucracy. Even with swift congressional approval, the president's initiative won't be felt in Africa for almost two years.

In contrast, the Global Fund to Fight AIDS, Tuberculosis and Malaria can deliver assistance in a matter of months. It has strong safeguards to ensure the proper use of funds and spends only 3 percent on administrative overheads. The fund also receives contributions from Europe and other wealthy nations to fight AIDS.

A recent trip to Mozambique showed me how much momentum a grant from the fund can provide. For the first time, the government, nongovernmental organizations, international agencies and the private sector are collaborating on a comprehensive AIDS plan there.

To reach the president's targets of preventing 7 million HIV infections and putting 2 million people on treatment, Congress should give at least half of any new AIDS money to the Global Fund. Instead, the fund is set to receive only $200 million annually of the $10 billion in new money over the next five years.

Last year the Senate unanimously approved legislation providing for $2.5 billion in spending to combat AIDS in the coming year, $1.2 billion of which was to be directed to the fund. Unfortunately, the House failed to pass the bill.

Bill First, the Senate majority leader and a co-sponsor of the Senate bill, should stand his ground in supporting the fund. Given the worsening AIDS crisis, Congress should provide $3.5 billion in total spending for 2004. And with a shortfall in the fund, Congress should approve an emergency contribution of at least $500 million this year.

An effective strategy to combat AIDS must also go beyond purely medical approaches. It should include better access to clean water and good nutrition and a range of community-based support services intended to meet the needs of affected families and the millions of children left behind by the AIDS epidemic. We must also address the broader, macroeconomic context by mandating debt cancellation so countries can have more money to combat poverty and disease.

The president has shown he is eager to confront the AIDS crisis. Now we must all work to ensure America lives up to the president's promise. Millions of lives hang in the balance.

The writer is executive director of the Global AIDS Alliance.

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