Will US AIDS cash make a difference?
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By Martin Hutchinson
BBC News Online health reporter
President Bush has signed into law a $15 billion package of measures
to help prevent and treat AIDS in poor countries. He hailed the pro-
gramme as a "great mission of rescue" - but what impact will the
money have?
The scale of the HIV epidemic in the developing world is difficult to
conceive from the relative safety of the West.
In turn, this hardly makes it a priority for the average voter, keep-
ing it low on the political agenda.
All of which made one of the central policy announcements of George W
Bush's State of the Union address earlier this year - funding for a
massive anti-HIV programme - all the more surprising.
"Seldom has history offered a greater opportunity to do so much for
so many," he said.
His "Emergency Plan" will involve approximately $3 billion a year for
the next five years to be spent both on providing medicines for those
who already have HIV, and trying to prevent new infections.
This is perhaps not entirely altruistic - UNAIDS believes that the
economic effects of an unchecked AIDS epidemic in Africa and beyond
will ripple out to hurt Western economies before long.
The extra money will undoubtedly have a significant impact on the
disease in sub-Saharan Africa and the Caribbean.
Rising challenge
However, experts say that even this fortune may not be enough to pre-
vent the epidemic running out of control for years to come.
And there is nothing for India, and other parts of the world where
new HIV infections are predicted to rise sharply over the next five
years.
Currently, researchers predict that, by 2010, there could be 45 mil-
lion new HIV infections worldwide if the disease spread is not
slowed.
In 2002, UNAIDS calculated that $10 billion should be spent each year
in less-developed countries to produce even an "adequate" response to
HIV.
Even with the Bush billions, the total falls well short of this.
Dr Peter Piot, the executive director of UNAIDS, said: "There is
still a long way to go.
"AIDS will only be defeated when responsibility for addressing it is
fully shared - with every nation working to meet the financial and
leadership challenges presented by this global epidemic."
Internal pressures
While there are calls for the US to increase the size of the pro-
gramme yet further, there remain doubts about whether the Bush ad-
ministration will be able to deliver the funds in an effective way to
the countries - and projects - where it is needed.
An analysis by the Global AIDS Alliance suggests that the billions
are to be phased in gradually, with just over $2 billion made avail-
able in 2004, rising to $3.8 billion in 2008.
"This is inappropriate from a public health standpoint," it says,
"because the epidemic is expanding exponentially now and there is ex-
tensive underfunding of currently available programmes that are ready
for scale-up".
There are also concerns that the programme has been left slightly
hamstrung by a concession made by President Bush to lobbyists.
This stipulates that a third of the money designated to prevention
work must be spent promoting sexual abstinence prior to marriage as a
method of protection.
This approach is seen by public health experts as less effective than
promoting the use of condoms and other safe sex practices.
Congress has to approve each year's allocation for the programme, and
some in Washington are expressing doubt over whether future year's
billions can fit within tight budgets set for foreign aid by the Re-
publicans.
While the new law allows for up to $15 billion over the five year pe-
riod, it does not bind the administration to this amount - the ad-
ministration could trim the programme in future years if it wished.
Other obstacles
Despite reservations from some on the front-line of the fight against
HIV - there is little doubt that most in the field are delighted with
such a major commitment from the world's largest power.
It could help provide leverage to elicit billions more in pledges
from other developed nations over the next few years.
The UK has allocated no new money for HIV/AIDS abroad since 2001, and
activists are hopeful that the upcoming meeting of G8 nations will be
the venue for its own announcement.
Campaigners say that action to cancel the debts of some of the worst-
hit countries could make the programmes yet more effective - as would
further significant price reductions in the cost of vital drugs.
They point out that the US, in the past, has supported moves to pre-
vent poorer countries making their own cheap generic versions of
anti-HIV drugs.
But, amid the calamity that has befallen entire generations in some
African states, there is reason for some optimism.
Some sub-Saharan African countries are already showing that well-
funded, carefully targeted prevention campaigns can have a pronounced
effect on the rate of new infections.
If the money is spent well, the expectation that many lives will be
saved is entirely justified.
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