IT WAS A dramatic moment, a year ago, when President Bush turned in his State of the Union address to the global AIDS pandemic and pledged $15 billion over five years. And when, in May 2003, the president signed the United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act into law, he seemed to be honoring the pledge. The law authorizes $15 billion over the next five years to fight HIV/ AIDS and other health crises in developing countries, with $3 billion for each fiscal year from 2004 to 2008. It calls, specifically, for $1 billion in 2004 in support of the Global Fund to Fight AIDS, Tuberculosis and Malaria.
President Bush made another pledge: To create something called the Millennium Challenge Account, through which the United States would channel a $5 billion increase in U.S. development assistance to the world’s poorest nations by 2006. The idea was to establish criteria — just governance, investment in human development and progression towards market-based economic reforms — for country eligibility for these funds.
On the surface, both initiatives seem laudable. Cynics might wonder about the timing of the announcements; the president, for example, announced the MCA just before the Monterey conference to confront global poverty, when the United States was anxious to appear more generous than it is. We might complain that the disinclination of the Bush administration to support the Global Fund to fight AIDS is yet one more indication of unilateralist tendencies. And those of us with an Africa focus might question an AIDS initiative largely directed toward only two Caribbean and 14 African countries, and an MCA initiative for which only three African countries are likely to be eligible at the outset. What happens to the rest of the world's poorest continent and to those suffering from AIDS worldwide?
These critiques aside, the AIDS and MCA pledges mark a major step forward in U.S. commitments. The fundamental test of this commitment is this: Show us the money! Despite the obvious urgency demanded by the AIDS crisis, and despite the implication that $15 billion over five years means $3 billion in 2004, President Bush asked for less than $2 billion for 2004 and considerably less than $3 billion for 2005. The Republican-controlled Congress, yet to pass appropriations legislation for the fiscal year 2004 that began in October 2003, plans to defy the president's call for lower figures and allocate around $2.4 billion for global AIDS. What they will do for 2005 is anyone's guess.
In any case, the figures are far short of a defined need for 2004 of $3.5 billion, the U.S. fair share of global contributions. As for the effective multilateral initiative, the Global Fund, President Bush only requested $200 million for 2004, down from $350 million in 2003. It looks as if the Congress will allocate more, but the final figure is unclear. It's sure to be less than the $1 billion called for in the U.S. Leadership legislation. The situation with the Millennium Challenge Account is similar. Originally the Bush administration sought $1.6 billion for fiscal year 2004, then cut it to $1.3 billion as the debate continued. Congress is poised to appropriate only $1 billion. The $5 billion increase pledge seems a long way off.
Senate Majority Leader Bill Frist (R-Tenneseee) commented during his trip to Africa last August that we need to "look at the face of HIV/AIDS and to walk the halls and look at the hundreds of people lined up just waiting for treatment." Only 50,000 Africans living with AIDS are receiving antiretroviral drugs, of an estimated need of 4,100,000. Yet Senator Frist refused to fight for more than President Bush wanted, saying we should not "just throw money at the problem."
Well, of course not. But the need is demonstrable, and the Global Fund is widely hailed as the most effective program around. Auditors at the Government Accounting Office have said that the key obstacle facing the fund is lack of money. As for development assistance generally, we've learned a lot in the last half century about aid, and there is a rich variety of alternatives to enhance effectiveness. It's simply untrue that a U.S increase in development assistance is "throwi money at the problem," and it's dishonest to high-profile pledges and fail to even ask tha pledges be honored.
The United States remains the least generou donor nation in the world, seen by the widely accepted standard of assistance as a percenta gross national product. At General Conventi year, we adopted a resolution endorsing the v of 0.7 per cent of GNP. With U.S. appropria hovering at less than one-tenth of one percen with dramatic "compassionate" pledges dishon ored, we've got a long way to go.
