Bush on AIDS: Competing Moral Imperatives

Craig Sterritt

Disclosures

AIDS. 2003;17(18s) 

In This Article

Going Global

Kevin Keane, Assistant Secretary for Public Affairs at HHS, has described the department as "ground zero for the ideological wars in this country." While abortion and condom debates have proven this to be true for decades, critics maintain that the Bush administration has substantially changed the rules of engagement, and not only on the domestic front.

Under the present administration, HHS has assumed an increasingly forward role in international policy, often taking on functions traditionally performed by the State Department. In a critical assessment of the Bush administration's international reproductive health policy, public health and policy analyst Susan Cohen posits this change as a move to give "DHHS officials the green light to 'go global' with their perception of the president's social agenda."

US delegations led by Secretary Thompson have candidly and aggressively promoted this agenda with respect to several important treaties and initiatives, including the UN Convention on the Rights of the Child. Further, HHS has figured largely in the development and administration of unilateral health programs that mirror the objectives of widely endorsed multilateral versions, but do not conflict with US policies or principles concerning contraception and abortion.

AIDS advocates who favor investments in multilateral efforts to prevent and treat AIDS on a worldwide scale are worried by the Bush administration's history and philosophy of unilateral/bilateral alternatives to cooperative international solutions. The Global Fund to Fight AIDS, Tuberculosis & Malaria is widely considered to be the most advanced and reliable mechanism for disbursing and overseeing myriad local grants to AIDS treatment and prevention providers in the developing world. But the Bush administration requested only $200 million for the Fund in 2004, the same amount as 2003. Congress intervened, and the Senate and House are currently working on legislation that would add another $200 million to $300 million, and as much as $1 billion, pending contributions from other donor nations.

The relative generosity of the president and of Congress toward the Global Fund likely reflects a difference of priorities with respect to cost and control: a larger allocation to an established, external, multilateral institution, the logic goes, is more cost effective from the taxpayer's point of view, but can be less tightly managed by the US executive branch. On the other hand, by channeling funds to new and existing bilateral programs administrated by HHS, the US Agency for International Development (USAID), and other US agencies, the Bush administration would retain firm control of how the money is spent. In this regard, despite language that implies protection of non-US programs that receive funds through Bush's AIDS initiative, the New York Times reported that the president's decision to stop funds from going to organizations that talk about or provide abortions has "effectively stopped condom provision in 16 countries and reduced it in 13 others."

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