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AS the Washington establishment and the main stream media paint it, a few conservative senators are holding up the AIDS-relief bill out of ideological crankiness. But the real issue is whether Democrats and the foreign-aid establishment will gut the provisions that have made the President's Emergency Plan for AIDS Relief so successful.
Since 2003, PEPFAR has dedicated $15 billion to relieving HIV/AIDS, tuberculosis and malaria - mainly in Africa, home to 12 of the program's 15 "focus" nations. President Bush this year asked Congress to reauthorize PEPFAR with double the funding. The House instead tripled funding to $50 billion. But it also added provisions to greatly benefit abortion providers.
No, abortion doesn't have much to do with AIDS, TB or malaria. That's the first clue as to who's really playing ideological games here.
But the White House is eager to keep a program that does so much good going - it cut a deal to pull the extraneous pro-abortion elements at the price of giving in on another liberal bugaboo: It signed off on a weakening of the program's core strategic emphasis on the "ABs" of prevention - Practice Abstinence and Be Faithful (monogamy).
From the start, PEPFAR has focused on "AB" over the "C" of distributing and promoting the use of condoms. AB had proved highly effective in Uganda, where AIDS prevalence has dropped from 30 percent to 6 percent. It has since helped make PEPFAR the most successful AIDS program across Africa.
Condom promotion is, of course, dear to the hearts of Western liberals, who are uncomfortable with promoting monogamy, let alone abstinence - and greatly prefer to consider both to be difficult, if not impossible. So what if they actually work in preventing the spread of AIDS?
Most foreign-aid groups and charities share the prejudices of Western liberals; if the law doesn't require them to use PEPFAR funds for programs that work, they'll tend to instead favor the ones they believe in - even if the African host governments disagree.
The new bill eliminates any requirement that prevention funds go to AB programs, leaving only a vague demand for "balance."
The bill also rejects another key to PEPFAR's success - the requirement that most dollars buy life-saving HIV/AIDS treatment - pills and medical care for widows and orphans - instead of fat consulting contracts for "experts." Such fund-diversion is frighteningly typical of other foreign-aid programs - and another reason they're less successful.
So that's the bill that the seven senators - led by Dr. Tom Coburn, the only practicing physician in the Senate - are holding up. But the White House is eager for a deal so President Bush can point to what America's doing against AIDS at the coming G-8 Summit, and push other nations to follow up.
But it'd be a shame to let ideologues gut a program carefully crafted to benefit HIV/AIDS patients, turning it into another fund to benefit foreign-aid "experts."
Consider: In its original version, 55 percent of funds had to go for treatment, enabling two million people to receive anti-retrovirals. The new bill hikes funding three-fold but treats only one million new patients.
Incidentally, the biggest providers of HIV/AIDS treatment are Catholic hospitals and clinics, which provide more than 25 percent of services worldwide. The providers of the more "exotic" programs that the new bill would favor are groups like Family Health International and Population Services International, whose focus is largely on condom "social marketing" in the name of HIV "prevention."
South Africa, locus of the world's most wide-reaching condom program, started receiving US support in 1991 when HIV prevalence was less than 1 percent; it's now 19 percent.
Some 14 percent of pregnant South African girls aged 15 to 19 now test HIV-positive - despite being bombarded with condoms since childhood.
So let's hope Coburn and his allies bring the Senate to its senses and restore the provisions that have made PEPFAR work. The last thing the world needs is another ineffective US foreign-aid program.
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