In what its supporters hailed as a milestone in the U.S. commitment to fighting the global spread of HIV/AIDS, the Senate approved by voice vote a five-year, $15 billion anti-AIDS package in the pre-dawn hours of May 15th.

But Africa and anti-AIDS activists complained after the vote that the bill retained serious flaws and warned that the $15 billion provided by the package still faces a number of legislative and executive obstacles before the money can actually be spent. “This bill is a check given to countries fighting AIDS, but it will come back marked ‘insufficient funds’,” noted Paul Zeitz, executive director of the Global AIDS Alliance. “Sadly, the president, and top congressional decisionmakers like (Majority Leader) Senator (Bill) Frist and (House of Representatives) Speaker (Dennis) Hastert seem to have little intentions of actually providing this level of funding. They are playing a cruel joke on countries battling for their very survival,” he added.

As examples, Zeitz pointed in particular to the prospect of major battles in Congress later this year over actually appropriating–as opposed to simply authorizing–the money. He also cited a recent White House statement that U.S. annual contributions to the cash-starved Global Fund to Fight AIDS, Tuberculosis, and Malaria should be limited to only $200 million–far short of both the one billion dollars authorized in the bill and the minimum needed for the Fund, a multilateral agency created to coordinate and expedite the delivery of anti-AIDS assistance to poor countries.

The bill’s passage was nonetheless depicted by its supporters and the administration as a major breakthrough and one that would enable President George W. Bush to arrive at next month’s Group of Eight industrialized nations’ summit in France as a champion of the poor, as well as war. “Congress has given the hope of life to millions of people in countries most afflicted by AIDS,” Bush said in a statement after the vote. “This historic legislation will enable us to provide critical treatment and care for millions who suffer and greatly expand successful prevention programs to help those at risk.”

And even some lawmakers who had hoped to eliminate certain restrictions that were put in the bill at the insistence of anti-abortion forces hailed the president’s commitment. “It is startling and I give credit where it’s due,” said Democratic Senator Richard Durbin. “The president’s commitment in the State of the Union address was historic.”

Bush Proposal

Bush first announced the package in that address before Congress at the end of January, saying the proposal would amount to a tripling of global anti-AIDS funding provided by Washington over the next five years. The proposal is specifically at 12 sub-Saharan African and two Caribbean countries where HIV rates are especially high.

It also contained some provisions, however, which disappointed anti-AIDS activists, who began lobbying lawmakers on Capitol Hill to make far-reaching changes in the proposal as it went through the legislative process. They objected in particular to the slow start to the program–it provided only $1.7 billion for fiscal year 2004 (which begins October 1, 2003)–despite the fact that Bush had described the devastation caused by AIDS, which is killing more than 5,000 Africans every day, as an “emergency.” They also insisted that the $200 million a year limit on U.S. contributions to the Global Fund would quickly bankrupt the agency, in part because other major donors ordinarily tied their own contributions to Washington’s.

Indeed, the Global Fund, which is chaired by Bush’s Health and Human Services Secretary, Tommy Thompson, is currently facing a budget of $1.3 billion to fund projects through October. The Fund’s management has estimated it will need seven billion dollars over the next two years to keep pace with demand.

Show Me The Money

As the bill moved through Congress, lawmakers decided to increase the allocation to the Global Fund to as much as one billion dollars a year and to authorize the expenditure of a full three billion dollars for fiscal 2004. But the wording of the bill gives discretion to the president as to how much he actually wishes to spend. Much to the activists’ dismay, the White House has made clear that he intends to stick to his original proposal for both a slow start and a limited amount for the Global Fund. This will have devastating consequences on the ability of the Global Fund’s to achieve its mission. As noted in a recent report from the U.S. Congress’ Government Accounting Office, “the [Global] Fund’s ability to approve and finance additional grants is threatened by a lack of sufficient resources. Pledges made through the end of 2003 are insufficient to cover more than a small number of additional grants and without significant new pledges, the Fund will be unable to support all of the already approved grants beyond their initial 2-year agreements.”

Durbin himself sought to amend the final package Wednesday night to require the president to contribute at least $500 million to the Global Fund in 2004, but it was rejected 48-52 in the first of a series of defeats of amendments by Democrats designed to reduce the number of strings that are tied to disbursement of the money.

The Durbin amendment also tried to correct another major deficiency in the legislation that limited the amount of money the U.S. could contribute to the Global Fund. As drafted, the legislation provided that the president could contribute up to one third of the total contributions made by “other” donors to the Fund; a formula that would not include the U.S. contribution. The inclusion of “other” was apparently a drafting error, because the original sponsors said Washington should provide as much as one-third of total contributions. Thus, even for the U.S. to maintain its current level of donations, $350 million in 2003, other sources would have to donate $1.4 billion. As a result, “this bill asks European and other nations to assume such a large share of the burden that it will prove unworkable,” Zeitz said. “In that sense, it is a step backward.” He blamed the White House rush to get the law passed before Congress recesses next week on the failure to correct the problem.

Democrats also failed to strip from the final bill several other provisions strongly opposed by anti-AIDS groups. Those included a requirement that a third of all funds allocated for AIDS prevention under the program be used to encourage abstinence and another that would permit religious-based agencies to opt out of condom-distribution programs or to even deny information about condom use to their clients. These provisions “represent the triumph of fundamentalist dogma and ideology over science and public health,” said Salih Booker, executive director of Africa Action, a grassroots lobby group.

The one amendment that was approved called for greater consideration by the U.S. and donors to providing debt relief for African nations as another way to provide resources necessary to fight the spread of the disease. But the amendment was non-binding. “You might think that the U.S. government has finally made a major decision to provide leadership needed in the war on AIDS,” said Booker. “But you would be wrong.”