Bush on AIDS: Competing Moral Imperatives

Craig Sterritt

Disclosures

AIDS. 2003;17(18s) 

In This Article

A Moral Imperative

In spite of the numerous considerations and criticisms discussed in these pages, it is clear that President Bush has made a meaningful moral investment in changing the deadly tide of the AIDS pandemic. And if some of his administration's tactics may be less than realistic, it certainly grasped the magnitude of the crisis and of the resources required to address it. Bush's global AIDS initiative is larger and more in scale with the problem than any before it, and the President proved to be a responsible shepherd of its enactment through both houses of Congress.

The depth and durability of President Bush's commitment has yet to be demonstrated, however. And as the sensation of his original pronouncement has faded, even the president's supporters admit concern over his failure to follow through on AIDS (and other 'compassionate conservative' agenda items) with the same ardor that he did with his tax cuts and the war in Iraq. Critics also worry that the economic consequences of these latter Bush priorities could jeopardize the appropriation and allocation of designated AIDS funds.

Already, the president has dismayed AIDS workers by requesting only two-thirds of the $3 billion slated for 2004 by explaining that due to infrastructure problems, US programs couldn't "ramp up fast enough to absorb that amount of money." More recently, in October 2003, administration officials urged the Global Fund to delay its next round of spending in order to avoid potential accounting or solvency pitfalls (the administration has not publicly stated its specific concerns). The Global Fund has no apparent 'absorption' problem; on the contrary, it is facing a budget gap for grants approved for 2003. Supporters of the fund view it as the logical destination for US AIDS monies not allocated to other programs, and regard the administration's ostensible preoccupation with fiscal cautiousness as retrograde with respect to the very issues of infrastructure that Bush says are presently limiting international AIDS efforts.

The president's present readiness to slow global AIDS spending stands in sharp contrast to the moral imperative of aggressive action he trumpeted in January 2003. Bush still has the opportunity to live up to the word and spirit of his AIDS promises, to save the lives of millions of people, and to be credited as the world leader who turned the tide of the AIDS pandemic but that opportunity will not be there for long, unfortunately. Let us hope that George W. Bush remembers what lies in the balance and acts before it is too late.

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