President Bush Signs Into Law $15B International HIV/AIDS Bill; Some Democrats Say White House Commitment ‘Hollow’

President Bush yesterday in a ceremony at the State Department signed into law a bill (HR 1298) that authorizes $15 billion over five years to fight AIDS in Africa and the Caribbean, the Washington Post reports (Goldstein/Morgan, Washington Post, 5/28). The House last week approved the final version of the measure after the Senate earlier this month passed an amended version that would increase funding for debt relief in countries hit hardest by HIV/AIDS. The law, sponsored by Rep. Henry Hyde (R-Ill.), authorizes $3 billion a year for five years to international HIV/AIDS programs, with up to $1 billion in fiscal year 2004 going to the Global Fund to Fight AIDS, Tuberculosis and Malaria. The law endorses the "ABC" HIV prevention model -- abstinence, be faithful, use condoms -- which has had success in lowering HIV prevalence rates in Uganda. The package recommends that 55% of direct aid go to treatment programs, 20% to programs aimed at preventing HIV infections, 15% to palliative care and 10% to programs assisting children who have lost one or both of their parents due to AIDS-related causes. The measure also specifically allocates one-third of the bill's HIV/AIDS prevention funding for abstinence programs (Kaiser Daily HIV/AIDS Report, 5/27).

'Follow Our Lead'
Bush said, "In the face of preventable death and suffering, we have a moral duty to act, and we are acting" to address "one of the most urgent needs in the modern world." He added, "The United States of America will take the side of individuals and groups and governments fighting HIV/AIDS in Africa and other parts of the world. We'll provide unprecedented resources to the effort. And we will keep our commitment until we have turned the tide against AIDS." Bush also said that he would "challenge" other nations to "follow our lead" by contributing to the fight against HIV/AIDS during the G8 summit next week in Evian, France, reminding them that "time is not on our side" (White House release, 5/27). During the ceremony, U.S. Secretary of State Colin Powell said, "HIV is one of the biggest killers on the face of the earth. It is more devastating than any army, any conflict, or any weapon of mass destruction. Responding to HIV/AIDS is not only a humanitarian and a public health issue; HIV/AIDS also carries profound implications for prosperity, democracy and security" (Department of State release, 5/27).

Funding
Now that Bush has signed the measure, the "spotlight switches to making sure Congress ... actually come[s] up with the money" authorized in the law, the San Francisco Chronicle reports (Epstein, San Francisco Chronicle, 5/28). Some "[k]ey" congressional Democrats said that the White House's commitment to the initiative is "hollow," noting that while the bill calls for $3 billion a year for five years, the Bush administration in its FY 2004 budget proposal only recommended $1.7 billion for the initiative (Washington Post, 5/28). Fred Dillon, policy director for the Pangaea Global AIDS Foundation, said, "The devil is really in the details. Between the tax cuts and all the money being spent on terrorism, there's little discretionary money left. It will be extremely difficult" to garner the funds specified (San Francisco Chronicle, 5/28). Jeffrey Sachs, special adviser to U.N. Secretary-General Kofi Annan, said, "All $3 billion is urgently needed. We're talking about real numbers, but not the numbers that can win this battle." Paul Zeitz, director of Global AIDS Alliance, said, "Funding for the bill is what matters now," adding, "Otherwise, it's a lot of empty rhetoric" (Riechmann, AP/Philadelphia Inquirer, 5/28). Global AIDS Alliance yesterday released a report, titled "Fund the Fund to Save Families and Communities," that "details how the president's spending proposals will make the bill almost impossible to implement," according to a release (GAA release, 5/27).

'Long Way To Go'
Mark Isaac, vice president of the Elizabeth Glaser Pediatric AIDS Foundation, said, "There is no question that this represents a whole new day" in the United States' fight against AIDS, adding, "But we have to hold everyone's feet to the fire, including Congress and the president, in getting the dollars" (Zwillich, Reuters Health, 5/27). Rep. Barbara Lee (D-Calif.) said, "I have to be cautiously optimistic. I think it would be morally wrong to move this bill forward and raise the hopes of millions who are dying of this pandemic and then not come through" (San Francisco Chronicle, 5/28). Peter Piot, executive director of UNAIDS, said, "For the first time, there is a concerted global effort to close the treatment gap that denies life-saving HIV medicines to 95% of the people living with AIDS around the world" (AP/Washington Times, 5/28). He added, "With today's bill signing, the world moves an important step closer to supporting a response that begins to match the magnitude of the challenge. But there is still a long way to go" (Entous, Reuters, 5/27).

More Reaction

• AIDS Action: The bill is unprecedented in the size of its commitment, its unanimous support from Congress and its innovative approach to the use of debt relief in exchange for a countries' commitment to domestic health care, according to an AIDS Action release. "This is just the kind of leadership that the HIV/AIDS response needs," Dr. Marsha Martin, executive director of AIDS Action, said (AIDS Action release, 5/27).
  
• AIDS Healthcare Foundation: "President Bush said this effort will be judged by how many lives are saved, and we couldn't agree more. We deeply appreciate the president's commitment, which he repeated today to work closely with community organizations here and abroad," AHF President Michael Weinstein said. In addition, AHF calls for funding from the bill to be swiftly appropriated in Congress as well as for a "quick scale-up" of antiretroviral clinics in Africa and the Caribbean (AHF release, 5/27).
  
• Florida AIDS Action: FLAA Executive Director Dr. Gene Copello said, "[I]t's essential that we continue to advocate for Congress to appropriate the requested funds for this initiative," adding, "Otherwise, we've offered false hope to millions of men, women and children in Africa and the Caribbean" (FLAA release, 5/28).
  
• Focus on the Family: Focus on the Family "applauded President Bush for putting people before politics" in his support of the bill, according to a release. The group is "pleased" that the legislation made abstinence-based prevention programs a "priority," Tom Minnery, vice president of public policy, said (Focus on the Family release, 5/27).
  
• Global Health Council: "[T]hose of us on the front lines of AIDS care and prevention" can now confront the challenge of "craft[ing] and implement[ing] culturally sensitive comprehensive AIDS programs," Dr. Nils Daulaire, president and CEO of GHC said. Daulaire also encouraged Congress to implement the necessary funds, adding that "[f]unding for this initiative must not be taken from other important global health programs" (GHC release, 5/27).
  
• International Association of Physicians in AIDS Care: The bill is a "response commensurate to the tremendous challenges we face and equal to our nation's moral obligation to do more for those most vulnerable among us," Jose Zuniga, president and CEO of IAPAC, said. Other nations must "follow suit" in this "historic step forward to face squarely one of the most terrible threats to human security," Zuniga said (IAPAC release, 5/27).
  
• World Vision: World Vision President Richard Stearns commended Bush and Congress for their "unified, compassionate and generous response" to the AIDS epidemic and expressed hope that the measure would encourage other world leaders to step up their commitment to fighting the disease. The president and Congress are also to be commended for the "unprecedented" speed with which the bill was passed, Stearns said (World Vision release, 5/27).
  

Media Coverage
The following broadcast programs reported on Bush's signing of the bill:

• C-SPAN's "Washington Journal": The program discussed the bill with Dr. Joseph O'Neill, director of the White House Office of National AIDS Policy ("Washington Journal," C-SPAN, 5/28). The full segment will be available online in RealPlayer after the broadcast. In addition, O'Neill yesterday answered questions in the online interactive forum "Ask the White House." A transcript of the chat is available online.
  
• NBC's "Nightly News": The segment reports on successful HIV prevention work in Haiti and includes comments from Dr. Jean Pape, director of the Gheskio Center in Port-au-Prince, and Dr. Marie Marcelle DesChamps, co-director of the center (Bazell, "Nightly News," NBC, 5/27). The full segment is available online in Windows Media.
  
• PBS' "NewsHour with Jim Lehrer": The segment reports on how Haiti will benefit from funding through Bush's plan and includes comments from Dr. Paul Farmer, founder of Partners in Health and professor in the Program in Infectious Disease and Social Change in the Department of Social Medicine at Harvard Medical School; and Pape (de Sam Lazaro, "NewsHour with Jim Lehrer," PBS, 5/27). The full segment is available online in RealPlayer.
  
• PBS' "NewsHour with Jim Lehrer": The program also includes an interview with Senate Majority Leader Bill Frist (R-Tenn.) about the bill (Lehrer, "NewsHour with Jim Lehrer," PBS, 5/27). The full transcript of the interview is available online. The full segment is available online in RealPlayer.
  
• PRI's "The World": The segment includes comments from Stephen Lewis, the U.N. Secretary General's special envoy for HIV/AIDS in Africa; Sachs; Bruce Walker, professor and chair of the Division of AIDS at Harvard Medical School; and Simon Wright with the U.K. charity Action AID (Bell, "The World," PRI, 5/27). The full segment is available online in Windows Media.