Activists Fear Drop in AIDS, Reform Funding

Amid the discord over administration foreign policy, President Bush has won wide acclaim for two initiatives: helping overseas AIDS (search) victims and countries that adopt democratic reforms.

But those ambitious goals could be imperiled by the realities of an expensive war and a growing budget deficit.

"In the face of preventable death and suffering, we have a moral duty to act, and we are acting," Bush said in May 2003, when he signed a five-year, $15 billion bill aimed mainly at HIV and AIDS sufferers in sub-Saharan Africa. Congress passed the legislation just four months after Bush proposed it in his State of the Union address.

But in Washington, approving or authorizing a program does not necessarily mean the money will be there when Congress passes its annual budgets. So far, Congress has not come up with the $3 billion a year average, appropriating $2.4 billion in the 2004 budget year and $2.9 billion for 2005.

House Minority Leader Nancy Pelosi urged Bush to live up to his pledge to provide the full $15 billion. "So far, his budgets have fallen far short," the California Democrat said.

The administration insists it always planned to increase spending gradually as new programs got organized and became better able to put the aid to good use.

Rep. Jim Kolbe, R-Ariz., who heads the House Appropriations subcommittee responsible for foreign aid, said the $2.9 billion was the largest amount ever appropriated for a disease program in a single year.

Seth Amgott, spokesman for DATA (search), the group headed by rock star Bono that lobbies for aid for Africa, said he expects the United States to come through. "It would be shocking for the richest, most powerful country in the world not to meet its commitment," Amgott said. "We see no sign of that."

But David Bryden, spokesman for the Global AIDS Alliance (search), said his organization fears Bush will try to keep spending flat in 2006 to pay for the Iraq war and make his tax cuts permanent.

The concern is that AIDS spending will fall victim even though the pandemic is widely considered a significant security risk, Bryden said.

Congress also authorized spending up to $1 billion in 2004 for the international Global Fund to Fight AIDS, Tuberculosis and Malaria (search). But the Swiss-based fund actually received only $400 million in 2004 and $338 million for 2005, including $88 million in money unspent in 2004.

Kolbe explained that the law limits U.S. contributions to one-third of the total collected and that other countries, including some in Europe, "did not step up to the plate last year."

Bryden blamed that in part on the administration, saying, "The United States doesn't really try very hard to get these other countries to kick in more money."

The Millennium Challenge Account (search), an idea Bush proposed in 2002, is in a bigger financial hole. The original goal was to provide more than $4 billion in the first two years and then $5 billion in 2006 to help poor countries that are trying to open markets, promote democracy and abide by human rights standards.

The administration asked Congress for $2.5 billion in 2005; Congress initially tried to cut that in half. Lawmakers agreed to $1.5 billion only after White House budget director Joshua Bolten (search) reminded them that this was a presidential priority and that if it got less money, the program could not provide multiyear support to the 17 countries that had qualified.

One problem was congressional delays in approving the government entity responsible for assessing proposals from countries. It did not formally begin work until last spring and has yet to approve a single compact. Negotiations with four countries - Nicaragua, Honduras, Madagascar and Georgia - are reportedly near conclusion.

Steven Radelet, senior fellow at the Center for Global Development (search), said he believed the AIDS initiative eventually will be fully funded. He is less confident about the Millennium Challenge Account because of budget pressures. "It's a little unrealistic to think Congress will agree to $5 billion" in 2005 or future years, he said.

Radelet also worries that, contrary to the two initiatives' original intent, they will be promoted at the expense of other aid programs. Lower-profile existing programs - money for the global environment or multinational development banks - "could begin to be squeezed, and I think that's where the danger is," he said.