President Bush said yesterday that U.S. support is helping to bring AIDS prevention and treatment to hundreds of thousands around the globe, as he marked World AIDS Day before an assemblage of top officials and a somewhat jet-lagged South African family flown in for the occasion.
The President's Emergency Plan for AIDS Relief (PEPFAR), which aims to spend $15 billion over five years, is helping to support 400,000 people on lifesaving antiretroviral therapy. Nearly all are in sub-Saharan Africa, where 12 of the plan's 15 "focus countries" are located. Three years ago, 50,000 Africans were receiving treatment.
"I believe America has a unique ability, and a special calling, to fight this disease," Bush said in a hall at the Eisenhower Executive Office Building.
Bush's speech, attended by five Cabinet secretaries and many ambassadors from African nations, came as the world is about to miss by a wide margin the goal of providing AIDS drugs to 3 million people from low-income countries by the end of 2005. The World Health Organization set that "3 by 5" target in 2003.
As of June, 970,000 people in low- and middle-income countries were on AIDS drugs, out of 6.5 million who urgently need them, according to WHO. In all, 40.3 million people are living with HIV infection worldwide. Slightly fewer than 5 million people became infected this year, and 3.1 million died.
The Bush program spent $2.4 billion in 2004, its first year, and is spending $2.8 billion this year. The president has requested $3.2 billion for 2006.
The other large source of money for AIDS treatment in the developing world is the Global Fund to Fight AIDS, Tuberculosis and Malaria, which was founded in 2001 and is based in Geneva. It receives donations from countries and foundations, and awards grants to programs that meet specific criteria and performance standards.
The fund reported yesterday that it is supporting AIDS treatment for 384,000 people -- 60,000 more than six months ago, and nearly triple the number of a year ago.
Bush's program provides most of its funding through "bilateral" relationships with the 15 countries, an arrangement that is designed to give it greater oversight and control and that yields better publicity than if it worked primarily through the global fund. Even so, the United States is the biggest single contributor to the fund. It provided $600 million from 2001 to 2003 and has pledged an additional $1 billion. That $1 billion is part of the $15 billion cost of Bush's program. In the past two years, Congress has increased the appropriation above the administration's request.
Rapidly enrolling patients in treatment is a priority for both PEPFAR and the fund. At a meeting of the Group of Eight countries in July, Bush agreed with leaders of the other highly industrialized nations to work toward "universal access to treatment" for the world's AIDS patients by 2010 -- an even taller order than the 3 by 5 target or PEPFAR's goals.
David Bryden, a spokesman for the Global AIDS Alliance, said PEPFAR's contribution "is an important step, but we still have a long way to go before we reach universal access. . . . The U.S. cannot reach that goal alone. That's why the president will have to increase U.S. support for the global fund."
Bush's comments drew an immediate response from Howard Dean, chairman of the Democratic National Committee, who said the president had not provided all of the money he pledged in 2003.
"The Bush White House has talked a big game on fighting AIDS, but has consistently shortchanged the president's initiatives and stood in the way of important global efforts to curb this disease," Dean said.
On the stage behind the president at the AIDS event were three recipients of U.S.-supported treatment, Thandazile Darby, 35, and her two children, Lewis, 4, and Emily, 5, of Durban. All are HIV-positive, as was Darby's husband and the children's father, who died in 2002. The three are receiving antiretroviral drugs provided through a program supported by the Elizabeth Glaser Pediatric AIDS Foundation, which is funded in part by the administration's program.
While the president spoke, Emily, wearing a pink blouse, drew up her legs and lay down on her chair, her head on her mother's thigh. Lewis leaned his head back and nestled against Helga Holst, medical director of Durban's McCord Hospital, where the two children and 150 others are treated.
"It's the effect of a long speech," Bush said to laughter as he turned and introduced the family. "I want to thank you for joining us today, and I want to thank you for your strong example of courage."
Also attending was Peter Mugyenyi, 56, a physician from Kampala, Uganda, who began treating AIDS patients with triple antiretroviral therapy in 1996, the year that approach took off in the United States, where it has dramatically reduced AIDS deaths and restored thousands of people to near-normal health.
Mugyenyi was the first to use the multidrug regimen in Uganda, and one of the first in the region. He said there are now about 67,000 Ugandans on it, with PEPFAR helping to pay for about a third.
Backstage after the speech, Darby said she and her children have had dramatic responses to the drugs, which have not proved as onerous to take as she expected. In a 10-minute chat with the president and Laura Bush, she said she "thanked him for supporting us."
The Bushes invited the family to the lighting of the White House Christmas tree last night. They have tickets to see the baby panda at the National Zoo this morning and will fly home tonight.