This year, World AIDS Day on December 1 focuses on women and girls. The Bush administration says its Emergency Plan for AIDS Relief is helping address the health-related needs of women in Africa and other developing regions. But critics say, so far, the program falls short of the ambitious goals President Bush set out when he unveiled the initiative nearly three years ago.
Recent statistics from the World Health Organization paint a grim picture when it comes to women and HIV, according to U.S. Under Secretary of State for Global Affairs Paula Dobriansky.
"In sub-Saharan Africa, 57 percent of persons living with HIV/AIDS are now women," she said. "And women between 15 and 24 years of age are three to six times more likely to become infected than their male peers. Especially in the developing world, women shoulder the greatest burdens of HIV/AIDS, often bearing the brunt of caretaking for those who are ill, while themselves facing unequal access to medical care."
The Bush administration's Global AIDS Coordinator, Randall Tobias, says the United States is leading efforts to confront the problems and challenges faced by women in regions ravaged by AIDS. Mr. Tobias oversees President Bush's Emergency Plan for AIDS Relief: a five-year, $15 billion program to boost AIDS treatment and prevent HIV infection in 15 nations, most of them in Africa.
"The single most important thing the U.S. can do for women and girls is making prevention, treatment and care broadly available to them," he said. "One key example of that work is what we are doing in support of drug therapy and counseling to prevent mothers from passing HIV to their children at birth."
Yet congressional reports show spending falling short of levels proposed by the Bush administration for the program to prevent maternal HIV transmission, as well as the overall Global AIDS Initiative.
Laurie Garrett, senior fellow for global health at the New York-based Council on Foreign Relations, says the United States is nowhere near its five-year goal, announced in 2002, of supporting treatment for two million HIV-infected people.
"It falls a great deal short of what seems to have been promised," she said. "According to their [the administration's] own data, a total of 18,000 people in the world have gone on anti-viral therapy as a result, directly, of the president's program. More than that [number] went on anti-viral therapy in New York City alone in the three weeks following the 1996 AIDS meeting in which the efficacy of these drugs was first announced."
Critics also say the AIDS relief initiative suffers from ideology-driven mandates that satisfy social conservatives in the administration and Congress but which may hamper the fight against HIV in the developing world: specifically, the downplaying of sex education and condom distribution.
In addition, critics say the U.S. plan places costly barriers in the way of inexpensive anti-viral medications that can be manufactured in developing nations.
U.S. officials steadfastly defend the plan, noting that President Bush's emphasis on abstinence and marital fidelity mirrors the views of Ugandan President Yoweri Museveni, whose country has managed to lower what was once one of the highest HIV infection rates in the world.
On the question of access to cheaper medication, Global AIDS Coordinator Randall Tobias says the administration has implemented an expedited process for reviewing the safety and efficacy of drugs produced anywhere in the world.
"We are interested in finding the least expensive drugs we can find," he said. "But we also want to be sure that any of the drugs we are funding are safe and effective."
On funding, U.S. officials say more money will be spent as new programs expand to full capacity. In addition, they point to congressional provisions limiting U.S. contributions to 33 percent of the total budget of multilateral organizations involved in combating HIV. They say more could be spent if other countries increased their contributions, as well.
U.S. policies drew the ire of thousands of protesters at July's International AIDS Conference in Thailand. Laurie Garrett of the Council on Foreign Relations says vilification of President Bush's AIDS relief plan is unwarranted.
"No country is doing more [than the United States], and that is a sad statement on the level of commitment by the world community to this crisis," she said. "The U.S. commitment of $15 billion should not be looked upon as something to scoff [at]."
Ms. Garrett says, if Congress fully funds the initiative and meaningful assistance actually reaches large numbers of people, the president's initiative will prove itself a bold and worthy program.