Over the past year, President George W. Bush's Global AIDS Coordinator, Randall Tobias, has accomplished what few activists believed possible: he channeled hundreds of millions of newly appropriated funds to administer treatment programs for tens of thousands of AIDS patients in Africa and the Caribbean.
Yet despite this considerable achievement, certain aspects of the Bush administration's program have been highly controversial at home and abroad: the decision to purchase brand pharmaceuticals instead of generics for U.S.-funded treatment initiatives, for example, and the administration's circumventing the Global Fund to Fight AIDS, Tuberculosis and Malaria, by directing the bulk of its resources to its own initiative.
A third major controversy has surrounded the administration's approach to research and programs on HIV-prevention. The issue has been particularly divisive, because it pits firmly held views about condoms, abstinence, and homosexuality that divide religious conservatives and secular activists such as health professionals. Tobias faced the formidable challenge of keeping faith with the conservative Catholic and evangelical Christians who constitute President Bush's political base -- some of whom oppose essential prevention initiatives -- while funding enough medically sound strategies to meet the president's ambitious goal of preventing seven million AIDS transmissions in five years.
Tobias's job was further complicated by some of the decisions the U.S. Congress made for him in mid-2003, when it enacted the United States Leadership Against HIV, Tuberculosis, and Malaria Act of 2003, which laid the ground rules for the expenditure of billions of dollars worth of foreign aid for the prevention, care, and treatment of HIV/AIDS in sub-Saharan Africa and the Caribbean. Although the legislation represented a high-water mark of cooperation across political, religious, and ideological lines, some of its features made both the left and the right uneasy. Progressives were dismayed by a requirement that the executive branch spend a third of prevention resources on programs promoting abstinence before marriage. Right-of-center lawmakers, meanwhile, had to accept that two-thirds of the funds would be used for activities other than
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