By Marc Lacey

The Bush administration says that because too little money is coming into the Global Fund to Fight AIDS, Tuberculosis and Malaria, and too little is being disbursed and spent, that the three-year-old program ought to take a break from issuing grants. A decision on the postponement will be made later this week in Arusha, Tanzania, where the Global Fund's board is meeting. Tommy G. Thompson, the secretary of health and human services and the current chairman of the fund, is pushing for a delay in giving a fifth round of grants.

"Let's get the financial house in order before we make new obligations," said an official of the Bush administration, which some activists pressing for more money to fight AIDS say prefers to direct American taxpayer dollars to its own program to fight AIDS, the President's Emergency Plan for AIDS Relief, than to the Global Fund, which was founded by the United Nations. Those critics say that the American position will cost lives, and that delaying the grants will take pressure off donor countries to step up their giving. In the previous round, they said, the donors did not begin to commit money until after the grant process was well under way. Some are more critical of the West in general than of the United States. "The West has been negligent in supporting the resources to treat AIDS, malaria and tuberculosis and if round five is canceled, it would be kicking Africa when it is already down," said Stephen Lewis, the United Nations special envoy on AIDS.

The Global Fund has doled out $3 billion to about 120 countries since its founding in 2002. But the fund, which was set up to pool the resources of governments and private donors for a coordinated battle against the three diseases, has found itself seriously short of its financial goals. The fund had been set to solicit proposals for new programs in June, but an unexpectedly small flow of contributions prompted a six-month delay. The American delegation is now advocating a postponement of the next round of grants, into next year.

The secretary general of the United Nations, Kofi Annan, had said in early 2002, when he announced the formation of the fund, that he hoped it would increase global financing for AIDS to as much as $10 billion a year. The reality has been a far more modest average of about $1 billion annually at the fund. That is far below the $20 billion or more a year that it is estimated the world will soon need to combat AIDS.

Advocacy groups for people with AIDS are planning to protest outside the board meeting, beginning on Wednesday, to drive home the point to board members that people will suffer unless donors begin doling out more funds. "If it is delayed, I'm not sure if my clients will still be there to get any help," said Patricia Asero Ochieng, an AIDS counselor at Mbagathi District Hospital in Kenya. Kenya's request for grant money in 2004 was turned down, with the Global Fund advising the government to reapply in 2005. A postponement of the next round of grants would mean less money to treat the country's many AIDS victims, advocates say. "Delay means death," said Kassim Issa, an AIDS activist.

But American officials say that Kenya, which has been slow to spend the money it has already received, is a good example of why another round of financing is not merited right now. In one case, they say, Kenya's Ministry of Health spent Global Fund money on a public AIDS rally that was not authorized by the fund. The government intends to pay for the rally with its own money and use the grant money for the approved purposes, Kenyan officials have said. Even as it criticizes other countries for not doling out enough to the Global Fund, the Bush administration has disappointed many in its own financing levels. The White House requested $200 million for the fund in 2004, which Congress later increased to $547 million. Not all the money may be spent, however. Congress limited the United States to providing only a third of the Global Fund's total budget, and donations from other countries have not reached the $1.1 billion needed to earn the whole amount.

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