Global Policy Forum

By Sheryl Gay Stolberg

President Bush's initiative to spend $15 billion on global AIDS programs, a central element of his compassion agenda, is getting bogged down in partisan disputes over how to spend the aid and whether the money should be steered away from international clinics if they promote abortion.

The White House proposal, which would triple spending on international AIDS programs over the next five years, was widely expected to sail through Congress when President Bush announced it in January in his State of the Union address. But officials now say the window of opportunity for passing a bill in short order is closing.

"The hope for something quick has sort of escaped us," an aide to a senior Senate Republican said.

There are two main problems. First, Democrats and Republicans are at odds over how much money should go to a global fund to fight AIDS. The White House wants $200 million this year, but some Democrats, notably Senator John Kerry of Massachusetts, a presidential hopeful, want more, as much as $1 billion.

Perhaps more important, the initiative has gotten caught up in the complex politics of abortion in the wake of a recent decision by President Bush involving the so-called "global gag rule."

The rule, also known as the Mexico City policy because that is where President Ronald Reagan first announced it, prohibits international family planning clinics from receiving taxpayer dollars if they promote or perform abortions. President Bush, pressed by abortion opponents to extend the rule to clinics that also have AIDS programs, has instead decided on a compromise: organizations can perform abortions and can receive global AIDS money, as long as they keep the programs strictly separate and account for the money.

Some conservatives in Congress, including Senator Sam Brownback, Republican of Kansas, are pressing for the White House decision to be written into law. People on both sides of the issue say such a move could derail an AIDS financing bill.

Leading Republicans, including Senator Bill Frist of Tennessee, the majority leader, and Representative Henry J. Hyde of Illinois, the chairman of the House International Relations Committee and a fierce opponent of abortion, are working feverishly to make certain that does not happen, and have been discouraging colleagues from seeking to insert language relating to the Mexico City policy into the bill.

"I want the AIDS bill to pass," Mr. Hyde said, "and I think misdirected attention to other issues might overly burden the AIDS bill."

Advocates for people with AIDS say it is essential that family planning clinics be eligible for global AIDS money, because they care for pregnant women who may be infected with the AIDS virus.

"Any extension of the gag rule," said Representative Elijah E. Cummings, chairman of the Congressional Black Caucus, "would be turning a blind eye to the facts and would greatly hinder the effectiveness of global H.I.V./AIDS programs."

But Dr. Frist, who has been a leading proponent of the AIDS initiative, said in an interview that if the language "must be in the bill, I would likely support it."

Mr. Bush's initiative, announced on Jan. 28, would provide $15 billion over five years to provide prevention programs and treatment for people with AIDS in 12 African nations, as well as Haiti and Guyana. It drew praise from Republicans and Democrats, as well as many advocates for people with the disease, and quick passage was expected.

Last year, the Senate unanimously passed legislation, sponsored by Mr. Kerry and Dr. Frist, that would have sharply increased global AIDS financing, and authorized $2.2 billion for the global fund over the next two years.

But Mr. Bush argues that the two-year-old global fund, created by Kofi Annan, secretary general of the United Nations, does not have a proven track record. The White House wants the State Department to disburse the bulk of the new AIDS money.

Dr. Frist says he agrees with that position, and has taken his name off the Kerry-Frist bill. That irritated Mr. Kerry and other Democrats, including Senator Joseph R. Biden Jr. of Delaware, a strong proponent of increasing financing for global AIDS.

In an interview this week, Mr. Biden said he questioned the president's commitment to the cause. "Show me the money," he said.

The partisan fighting has meant that panels in both the House and the Senate have had difficulty drafting legislation to enact the president's proposal. In the House, lawmakers say they are nearing a deal, and Mr. Hyde is expected to introduce a bipartisan measure within days.

In its current form, Mr. Hyde's measure would authorize the administration to spend $3 billion each year, for the next five years, on global AIDS. That is in contrast to Mr. Bush's proposal, which would spend a total of $15 billion over the next five years, but would authorize only $2 billion in the first year.

But in the Senate, Richard G. Lugar, the Indiana Republican who is chairman of the Foreign Relations Committee, who has been trying to draft a bipartisan bill, said he had no idea when a measure will be ready.

"It's a very difficult matter, because there are a variety of people, all who want to do good in their own way," Mr. Lugar said, adding, "I would like to have gotten an AIDS bill concluded this week, but that's not possible given the differences of opinion."

Mr. Lugar said he did not believe that those differences were insurmountable. But advocates for AIDS patients fear that if Congress does not act quickly, it will soon become consumed with other matters.

"It could tie up the AIDS funding bill for weeks and weeks and weeks," said Holly Burkhalter, an official with Physicians for Human Rights, an advocacy group based in Boston, referring to the fight over the Mexico City policy. "If we don't pass a good global AIDS authorizing bill in the next couple of weeks I think our window is closed."

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