U.S. Cuts Number of Delegates to World AIDS Meeting

Nils Daulaire, a former official of the U.S. Agency for International Development who now heads a Washington-based advocacy group called the Global Health Council, said "there's a shibboleth that these [conferences] are junkets, but they are not. They are intensive and hard work. You don't get many opportunities to get the critical mass that you do at a meeting like this. I always come out . . . having learned something that I hadn't even thought about."

This year's conference is expected to be especially large -- as many as 20,000 participants -- and important because of major new efforts to bring AIDS treatment to the Third World. The biggest of those is the President's Emergency Plan for AIDS Relief (PEPFAR), which aims to treat 2 million people with antiretroviral drugs, and prevent 7 million HIV infections over the next five years.

Despite its size and ambitions, PEPFAR has been criticized. Complaints include the decision to limit aid to 15 named countries; the promotion of AIDS-prevention strategies that emphasize abstinence; and the requirement that foreign-made generic drugs used in the program must be approved by the Food and Drug Administration.

Many people urging greater U.S. commitment to combating AIDS globally -- including numerous members of Congress -- also believe PEPFAR should give more money to the Global Fund to Fight AIDS, Tuberculosis and Malaria, an entity created 2 1/2 years ago at the suggestion of U.N. Secretary General Kofi Annan. The Bush program is committed to giving $1 billion of the $15 billion in PEPFAR money to it.

The decision to limit U.S. participation in the Bangkok conference is sending a message the rest of the AIDS world will not miss, said a senior CDC official who declined to be identified.

"It's a perception from the rest of the world that the U.S. wants to be engaged, but the U.S. wants to call the shots," the official said.

The decision has caused consternation at the CDC and the NIH and among AIDS scientists outside the government whose work is funded by those agencies. Almost nobody was willing to speak on the record because of fears of retaliation.

"What can I say? I can't say anything," an anguished NIH researcher said.

Calling the decision "inappropriate and misguided," one AIDS scientist said that for the NIH staff "it is quite demoralizing to get an abstract accepted in the field of your choice, and then not be able to present your findings because you're not allowed to go the meeting."

Jack Whitescarver, director of the NIH Office of AIDS Research, declined to be interviewed. The NIH released details of the cutbacks only in response to a Freedom of Information Act request.