Bush Seeks ‘Immediate Release’ of $500M to 15 PEPFAR Countries, $20M to ADAP Program
President Bush in Philadelphia on Wednesday said he would seek the "immediate release" of $500 million as part of the President's Emergency Plan for AIDS Relief, amid criticism that the program is "moving too slowly," USA Today reports (Benedetto, USA Today, 6/24). Bush, speaking about HIV/AIDS and "compassion" at Greater Exodus Baptist Church in Philadelphia, said that $500 million is "on its way" and called on Congress to release the funding. He said the grants will provide more antiretroviral treatment, promote prevention efforts and provide care for AIDS orphans. The president also said that some of the money will go toward building countries' infrastructures because "part of the challenge we face is to help poor countries have the capacity to absorb the drugs and compassion of America." He added, "[W]e really don't care here in America if it takes a bicycle or a moped to get antiretrovirals out of these big cities, but that's what we're going to do." Bush said he wants to "make sure the resources [for PEPFAR] keep coming on a timely basis" (White House transcript, 6/23). PEPFAR this year has allocated $350 million to combat HIV/AIDS for the 15 eligible "focus countries," the Philadelphia Inquirer reports (Fitzgerald, Philadelphia Inquirer, 6/24). Tom Flavin, spokesperson for Ambassador Randall Tobias, head of the State Department Office of the Global AIDS Coordinator, said that the $500 million in grants will be distributed to focus countries "in a matter of days to a variety of organizations," the San Francisco Chronicle reports. Flavin added that the combined programs under PEPFAR should provide antiretroviral treatment to 200,000 HIV-positive people by the end of the year, according to the Chronicle.
As expected, Bush also announced that Vietnam will be the 15th country to receive funding under PEPFAR, the Chronicle reports (Russell, San Francisco Chronicle, 6/24). PEPFAR originally included 12 African nations -- Botswana, Ethiopia, Cote d'Ivoire, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia -- and Haiti and Guyana in the Caribbean. Although currently there are about 130,000 HIV-positive people in Vietnam, some analysts predict that number could increase eight-fold to one million people by 2010. If the projections are correct, the increase would be greater than predicted increases in India, Russia or China, which are three of the countries considered to be in the next wave of the pandemicc. The country could be considered a controversial choice because some lawmakers had called for the president to select India as the next focus country (Kaiser Daily HIV/AIDS Report, 6/23). State Department spokesperson Richard Boucher said, "Swift, focused American action can radically change Vietnam's disease" (State Department release, 6/23).
The president also announced that the administration would make available $20 million for AIDS Drug Assistance Programs in states with waiting lists for HIV-positive people to receive antiretroviral drugs, the AP/Las Vegas Sun reports (Lindlaw, AP/Las Vegas Sun, 6/23). ADAPs -- which are supported with both state and federal Ryan White CARE Act funds -- provide HIV/AIDS-related medications to low-income, uninsured and underinsured HIV-positive individuals (Kaiser Daily HIV/AIDS Report, 6/23). Bush said that the administration would "divert" the money from an "unrelated health program" to provide assistance to 10 states that have ADAP waiting lists and "chronically overstretched" programs, the Washington Post reports (Goldstein, Washington Post, 6/24). Bush said that several state ADAPs have "long lines" for antiretroviral drugs, which "seems like a problem that [the administration] can deal with, [a]nd we're prepared to help deal with it." The president added, "It's one thing to spend money, it's another thing to spend it wisely" (White House transcript, 6/23).
Ryan White CARE Act
During his speech, the president also pointed to his support for the reauthorization of the Ryan White CARE Act, the federal law that authorizes spending for HIV/AIDS treatment and prevention programs in the United States (Kaiser Daily HIV/AIDS Report, 6/23). Bush said that the measure "takes too little account of the most urgent needs" of people living with HIV/AIDS, according to the Post. He added that the administration should have increased authority to determine how funding is distributed, with more focus on subsidies for medicine and doctor visits, the Post reports (Washington Post, 6/24). Bush proposed making the measure "stronger and more effective by focusing resources on life-extending care, such as antiretroviral drugs and doctor visits and lab tests." He said that this "kind of care was just a dream 20 years ago" but "is a reality today," adding that the administration will "work with Congress to make sure that as many patients as possible are receiving the modern care they deserve." Bush also said that the "rigid geographical formula" that is used to make decisions for Ryan White funding should be changed to allow the administration to "set priorities" for funding because some areas of the country face "more severe" HIV/AIDS case loads. Bush said that HHS Secretary Tommy Thompson should have the "flexibility to cut through the red tape and get the money quickly to where it is needed," adding that the government also should "hold accountable" groups that receive federal funding for HIV/AIDS projects by monitoring their progress (White House transcript, 6/23).
Bush also focused on the "value" of faith-based groups as providers of HIV/AIDS care, according to the Chronicle (San Francisco Chronicle, 6/24). Bush said that for many people living with HIV/AIDS -- particularly those in low-income or rural communities -- local church programs are "their only source for treatment and support." He added that faith-based programs "deserve the support of our government when they're effective, not to be discriminated against" because they are associated with a religion. "People shouldn't fear the fact if there's a cross on the wall and an AIDS program in that building. We ought to welcome that. We ought not to fear the Star of David on a wall and an AIDS program ensconced in the building ... because the motivation by the people of faith is a motivation to help heal the hurt," Bush said, adding, "The faith-based groups are making a huge difference on the continent of Africa; they need to be making a huge difference here at home, as well" (White House transcript, 6/23).
According to the New York Times, Bush for the first time said that the United States should "learn from the experience" of countries like Uganda and support condom use as part of an HIV/AIDS prevention program. Speaking about domestic prevention programs, Bush said, "We can learn from the experiences of other countries when it comes to a good program to prevent the spread of AIDS, like the nation of Uganda. They've started what they call the 'ABC' approach to prevention of this deadly disease. That stands for: Abstain, Be faithful in marriage, and, when appropriate, use Condoms." Bush added that Uganda's program is a "practical, balanced and moral message," according to the Times. His comments "appeared to be offering something to both sides of the debate: his base of social conservatives as well as moderates ... who have argued that [he] has been too slow to embrace effective methods of preventing" HIV transmission, the Times reports (Sanger/McNeil, New York Times, 6/24). The law (HR 1298) authorizing the President's Emergency Plan for AIDS Relief endorses the ABC HIV prevention model and specifies that one-third of the bill's HIV/AIDS prevention funding should be used for abstinence programs (Kaiser Daily HIV/AIDS Report, 4/22). A Population Action International study in 2002 found that developing nations need 10 billion condoms a year but only receive 2.5 billion, the Times reports. However, the United States is the largest provider of condoms -- USAID donated 458 million condoms to developing countries in 2003 and is on track to distribute 550 million in 2004, according to USAID Assistant Administrator for Global Health Dr. Anne Peterson. The ABC prevention approach is "a science-based approach and for that reason is to be applauded," Mark Isaac , Elizabeth Glaser Pediatric AIDS Foundation policy director, said. However, PAI President Amy Coen said, "[I]t's one thing to use the word and another thing to actually fund it" (New York Times, 6/24).
About 150 people from several HIV/AIDS, labor and religious groups -- including ACT UP/Philadelphia -- protested outside the venue where Bush spoke, the Inquirer reports. Approximately 40 members of ACT UP/Philadelphia stood in front of a banner that said "Bush: Thou Shalt Not Lie About AIDS Funding" and tore up a fake $15 billion check addressed to "Big Pharma and Right Wing Extremists," according to the Inquirer (Philadelphia Inquirer, 6/24). Some HIV/AIDS advocates said that the president "shortchanged" prevention and treatment programs associated with the Global Fund to Fight AIDS, Tuberculosis and Malaria to focus on faith-based programs that stress abstinence, according to the Los Angeles Times. Health GAP Director of International Policy Asia Russell said that Bush's "stubborn and cruel unilateralis[t]" policy is "unfortunately ... costing the lives of people with AIDS" (Kemper/Wallsten, Los Angeles Times, 6/24). Terje Anderson, executive director of the National Association of People Living With AIDS, said that Bush is treating social services for HIV-positive people as "somehow icing on the cake" (Washington Post, 6/24).
'More Than Talk'
Presumptive Democratic presidential nominee Sen. John Kerry (Mass.) said in a statement that Bush "needs to do more than talk," according to USA Today (USA Today, 6/24). He added, "It is long past time for empty rhetoric on this issue. It is time for real resources and a real commitment that is based on science -- not politics -- to fight this epidemic" (Entous, Reuters, 6/24). AIDS Healthcare Foundation President Michael Weinstein said, "If the president's program is to be judged on the basis of lives saved, then it cannot possibly be considered a success at this point," adding that more than one year after PEPFAR was announced, the United States is providing treatment for only 2,000 people in developing countries (AHF release, 6/23). "It's critical to have AIDS leadership at the highest levels of government if our efforts are to be effective," The AIDS Institute Director of Federal Affairs Carl Schmid said, adding that although TAI does not "support all of the administration's policies on domestic and global AIDS, we commend the administration for their continued efforts to address a pandemic affecting some 46 million people worldwide" (TAI release, 6/23).
PBS' "NewsHour with Jim Lehrer" on Wednesday reported on Bush's speech on HIV/AIDS. The segment includes comments from Bush and Kerry (Holman, "NewsHour with Jim Lehrer," PBS, 6/23). The complete segment is available online in RealPlayer.