Proposal would more than triple funding for program that fights AIDS, but conservatives want restrictions on spending reinstated

President George Bush, right, presents the Presidential Medal of Freedom to Dr. Anthony Fauci, one of the men who helped develop the Presidents’ Emergency Plan for AIDS Relief. Republicans in Congress are blocking passage of the PEPFAR reauthorization because they disagree with efforts to expand the program’s funding and because they want more restrictions on how the funds can be spent.

WASHINGTON — At the White House on June 19, President George W, Bush awarded the Presidential Medal of Freedom to two people behind a triumph of his administration, a program to fight the global AIDS pandemic.

In Congress, a few Republican senators continued to block what would be a major expansion of that program.

Five years ago, at the urging of Bush, Congress approved $15 billion to fight AIDS, malaria and tuberculosis in Africa and other afflicted parts of the world.

The acclaimed program now supports anti-retroviral treatment for about 1.5 million and is on target to prevent 7 million new infections and provide care for 10 million, including orphans and vulnerable children.

The President’s Emergency Plan for AIDS Relief “has reached millions of people, preventing HIV infections in infants and easing suffering and bringing dying communities back to life,” Bush said in presenting the Medal of Freedom to Dr. Anthony Fauci, a leading AIDS physician, and the late Rep. Tom Lantos, a Democrat and a chief sponsor of both the 2003 AIDS legislation and the bill now before Congress.

Another big supporter of the AIDS act, which is known as PEPFAR, is Sen. Tom Coburn, a Republican and medical doctor who speaks of his own experiences in treating AIDS patients.

“There is no question that PEPFAR has been the most successful foreign aid program since the Marshall Plan,” Coburn said in a recent speech, referring to the U.S.’ post-World War II program to rebuild Europe.

But Coburn is also the leader of a group of seven conservative Republicans who have blocked Senate action on a bill, supported by the White House, that would more than triple funding for the program to $50 billion over the next five years.

The Senate Foreign Relations Committee approved the bill in March, and the House overwhelmingly passed a similar bill in early April, but resistance from the seven senators has effectively kept it off the Senate floor. The current act expires at the end of September.

Opponents have questioned the big increase in spending, but they also have policy differences. The current act requires that 55 percent of the money go to treatment programs, but writers of the new bill, arguing that people on the ground can better determine what programs are most effective, removed that obligation.

Coburn wants it restored. He says that without it there is danger of money getting diverted into unrelated development and poverty programs.

“Will we turn PEPFAR into just another bloated, unmeasured and unmeasurable foreign aid program with no accountability and no real impact?” he said.

Some conservatives are also leery of more money going into politically sensitive prevention programs involving the distribution of condoms, male circumcision or family planning.

Conservatives already have had to give up a provision in the 2003 act that required that one-third of all HIV prevention funds be spent on abstinence programs. In turn, liberals accepted some restrictions on family planning groups participating in AIDS programs.

Coburn, a budgetary hawk known for using parliamentary tactics to hold up bills, faces some heavyweight opponents in this battle. Presumed presidential nominees Sens. John McCain and Barack Obama are both co-sponsors of the Senate bill.

“Today an estimated 40 million people around the world are living with HIV/AIDS, with over 4 million new infections in 2006 alone, Obama said last week.

“I urge my colleagues to bring this important bill to the Senate floor for a vote as soon as possible,” he said.

Fourteen Republican senators, led by Richard Lugar, top Republican on the Senate Foreign Relations Committee, last month wrote Senate leaders urging quick consideration of the bill. PEPFAR, they wrote, “has served as a powerful demonstration of U.S. leadership and compassion throughout the world.”



This article appeared in the Dallas Voice print edition June 27, 2008.