AIDS Aid War

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Advocates will be fighting to nail down those commitments, because if they don't, the American pledge could wither. Currently the U.S. government has appropriated only $200 million for next year's contribution to the Global Fund. An Administration spokesman said he considered it "unlikely" that other donors will come up with the $2 billion, and points out that the law doesn't provide "an automatic trigger" for a full billion to the Fund even if they do. But having thrown down the gauntlet, Bush is now in the ring. Says Sharonann Lynch of the advocacy group HealthGAP: "If other heads of state challenge Bush back, what can he do but pay in his billion?"

As much as they welcome the competitive dynamic between the U.S. and other rich donors, experts don't want to let politicians get ahead of themselves in self-congratulation. "Right now we're spending about a tenth of what we need to fight this pandemic," says development economist Jeffrey Sachs, director of the Earth Institute at Columbia University. "You shouldn't get a prize for doing the most of a little bit." The Global Fund itself, which pays for aids treatment and prevention programs proposed by governments and civil society groups in the most afflicted regions, remains painfully underfunded. It has $400 million, but needs $600 million more to foot the bills for just half of the $2 billion in projects currently under consideration. Sachs argues that aids victims would have been better served if the U.S. had committed more of its money to the Global Fund, which is up and running efficiently, instead of to an untested program that could get as much as $9 billion in newly authorized funding over the next five years. "This President doesn't believe in putting money into organizations where he can't control the outcome," says Sachs. "The Administration deeply distrusts the rest of the world, and that's not a workable model."

The President is to be congratulated on his boldness. But now Bush needs to ensure that the check gets signed — BOB GELDOF, musician and Africa activist

The U.S. initiative on aids is being fueled by a bizarre and peculiarly American alliance. Where else could an aggressively self-confident and largely gay activist community find common purpose with the Christian right? Different aspects of the bill reflect the concerns of such disparate groupings as Act Up, the Abstinence Clearinghouse, drugmaker Merck and Co. and the Catholic Medical Mission Board. The aids consensus came about in part because scripture readings with Bono and the grassroots take-up of the Jubilee movement for debt relief have helped change the religious right's take on aids in the developing world: what was once seen by the religious right as a shameful "gay disease" has become a suitable object of Christian mercy.

There are limits, though. Last week poor countries meeting at the World Trade Organization in Geneva expressed "disappointment and frustration" at Washington's ongoing blockage of an agreement assuring cheap access to drugs for the developing world. American pharmaceutical companies claim they are willing to provide hiv-fighting antiretrovirals at cost for the poorest countries, since they don't want to be seen as profiting from an aids crisis that is devastating the African continent. But they worry that provisions would erode their patent rights for "lifestyle drugs" such as Viagra. The Fund has already decided that it will not shy away from buying generic antiretrovirals, whereas the U.S. bilateral program will more likely use patent drugs at cost — another reason some activists prefer the Fund's approach.

Milly Katana, an accountant with aids from Kampala, Uganda, doesn't care much about whether the rich world's money comes to her continent from France or America, bilaterally or through the Fund. "There's more than one way of addressing the problem," she says. "It's a welcome venture either way." Her country just got a first check of a $36 million grant from the Fund to provide antiretroviral drugs to the vast majority of aids sufferers who can't afford to buy them on their own. Two years ago Katana's group figured that money would be enough to treat 2,000 people; with generic drugs, she thinks they can save 4,000. Good news? Well, there are more than 1 million people living with aids in Uganda alone. But yes, says Katana, it's a good start. There is just so much further to go.