White House aides attributed Bush’s heightened moral concern about the spreading AIDS epidemic to eyewitness accounts brought back from Africa by Christian missionaries. That may be the case, but before we get too dewy-eyed about Bush’s transformation, what he has proposed is not all that it seems in the glowing headlines.
The announcement in Bush’s State of the Union Message gave every appearance that the United States was joining with the world community to attack a global scourge. But as information dribbled out, it became clear that the Bush administration would give only token support to a global fund established to combat AIDS and preferred to go its own way in deciding how its beefed-up contribution would be spent. What seemed a welcome counterpoint to an Iraq policy that much of the world sees as bullying may actually deal a blow to the world’s ability to combat the AIDS pandemic. By declining to put the bulk of the $10 billion in new spending he has promised over five years (which adds to $5 billion promised earlier) into a global fund created by the international community, Bush could be discouraging other nations from supporting the struggling fund.
Bush steered a token $1 billion over five years to the Global Fund to Fight AIDS, Tuberculosis and Malaria, just enough to refute critics who might accuse him of pulling out of the global organization the way he did the Kyoto protocol on the environment. By withholding U.S. money, Bush is threatening the global fund’s financial viability and perhaps its very existence at the same time Health and Human Services Secretary Tommy Thompson is taking over as the fund’s chairman of the board.
Although technically not a United Nations agency, Secretary-General Kofi Annan was instrumental in creating the independent, public-private organization. The Bush administration views it with distrust, as it does most international organizations. Bush’s cavalier treatment of the fund smacks of the same unilateralism that has earned him the contempt of much of the world on Kyoto and Iraq. “We shouldn’t get a nice round figure confused with what’s really going on in the fight against AIDS,” says an AIDS activist. President Clinton helped make the fund a reality, and the Bush administration has an “Anything but Clinton” mentality. Helping out Kofi Annan isn’t high on Bush’s list either. “Ten billion and only a billion to Kofi,” says the activist. “It’s poking Kofi Annan in the eye.”
Pique over the way the U.N. Security Council has turned his war action into a bureaucratic tangle may have prompted Bush to go it alone on AIDS. But with Thompson heading the fund, the debate over AIDS funding mirrors the split within the administration over Iraq. Secretary of State Colin Powell favors a more multilateral approach while Vice President Dick Cheney and the rest of the war cabinet think it’s more effective for a superpower to go it alone, even on AIDS. Thompson lobbied for the top spot in the fund, but he is in an awkward position. The day he takes over, the fund will announce a new round of grants for $866 million that will leave it broke. “A primary responsibility of the chairman is to raise resources, and we expect nothing less from him,” says a fund spokesman, noting that Thompson will need $1.2 billion a year to keep the fund operational.
This is about more than bureaucratic wrangling; it’s about control. If the administration works through the fund, it would be one of many voices on controversial issues. Encouraging condom use and distributing free condoms to young people is a problem for this administration given its conservative base. “Abstinence only for Africa,” a liberal activist quips. The administration removed information about the effectiveness of condoms from the Centers for Disease Control Web site. “Given their track record and their focus on abstinence, this is a concern,” says Sandra Thurman, who was the top AIDS official in the Clinton administration. “We have to be very frank with young people and arm them with the kind of information they need. It’s a deterrent, not a green light.”
AIDS activists worry about the administration’s cozy relationship with the pharmaceutical industry. Bush touted in his State of the Union address the fact that the cost of AIDS drugs has come down from $12,000 a year per patient to under $300, but that’s only if generic drugs are used. It’s unclear whether the administration has relaxed its commitment to protecting the franchise of the American drug companies. The suspicions of AIDS activists are well founded when it comes to the sincerity of the Bush administration’s commitment to fighting AIDS. Last June, Bush announced in a Rose Garden ceremony a $500 million plan to prevent pregnant mothers from passing the AIDS virus to their babies. Republican Sen. Bill Frist, who had made AIDS in Africa his cause, had championed the measure with former North Carolina senator Jesse Helms. Unbeknownst to most observers, the White House had quietly asked Frist to reduce the amount to $200 million, and Frist, being a loyalist, caved into the request. Even that money was never distributed. It was killed in an end-of-the-year crackdown on spending by the White House.
Bush’s new commitment of $10 billion drew cheers at the State of the Union address. But AIDS activists await proof. Their attitude is, in Hollywood jargon, show us the money.
