President Bush prices his commitment to AIDS relief in Africa at $15 billion — but that doesn't include the political capital he could lose for including condoms and generic AIDS drugs in the offer.
Mr. Bush's proposal was an about-face for an administration that has been mindful of Christian conservatives who say condoms promote promiscuity and pharmaceutical giants out to protect their patents.
AIDS relief activists who heard details of the plan Wednesday were stunned — and pleased.
"Inspiring and clearly heartfelt," said Sandra Thurman, the Clinton administration's top AIDS official who now heads the International AIDS Trust. "His plan can save millions of lives."
Salih Booker of Africa Action also welcomed the change. "This is a turnabout, in terms of emphasizing treatment instead of abstinence."
Generic AIDS drugs manufactured by Cipla, an Indian company, will be among those recommended to the 14 nations getting the help, said Anthony Fauci, a senior National Institutes of Health official.
As recently as November, Bush administration negotiators urged the World Trade Organization to confine generic knockoff drugs to domestic markets, and to ban their export. Western pharmaceutical companies holding AIDS drug patents have been major contributors to Mr. Bush's Republican party.
The administration has also discontinued a Centers for Disease Control and Prevention web page on reducing risky behavior among American teens, which advised practicing safe sex, and was revising a fact sheet on the effectiveness of condoms in preventing sexually transmitted diseases.
Fauci said condom distribution would be part of the prevention component — but so would abstinence education. Many Christian conservatives, a pillar of Mr. Bush's domestic support, have emphasized abstinence.
In a conference call with reporters, Fauci suggested that emphasizing either component — condoms or abstinence — unfairly skewed broad prevention policy.
"There are 12 points of prevention," Fauci said, including preventing mother-child transmission, media campaigns and making sure blood used in transfusions is safe.
Officials insisted that the proposal had little to do with politics.
"It's not about 'He's trying to get the African-American vote,'" said Jendayi Frazer, the top Africa adviser on the White House's National Security Council. "It derives from his sense of the need to preserve human dignity."
In Tuesday's State of the Union speech, Mr. Bush asked Congress to budget $10 billion in new money and $5 billion in already allocated assistance over five years to provide AIDS drugs to 2 million Africans, help prevent 7 million new infections, and care for those infected with the virus and children orphaned by the disease.
The funding starts with $2 billion in the budget year that will start in October.
Booker of Africa Action said he was not overly optimistic, citing Mr. Bush's failure to make good on an earlier plan to spend $500 million on preventing mother-to-child AIDS transmission. That plan now appears to be wrapped into the new one.
"They have become very good at the soft rhetoric, but not at the hard policy," said Booker.
The lack of specifics especially worried Booker, who wondered how — and when — the money would be distributed. He was also concerned at assisting just 12 nations in Africa — the other two are Haiti and Guyana — when the whole continent was under siege from AIDS.
"Why leave out Malawi and Zimbabwe?" he asked. "It can't be successful because borders are porous."
Fauci suggested the plan was short on specifics because much of the implementation would be left up to the regional authorities. He said the template would be Uganda's successful "network model," a system based on a central clinic directing satellites and one of the few in Africa reaching sufferers in rural areas as well as in cities.
Dr. Peter Mugyenyi, who heads the Ugandan program — and who was Laura Bush's guest at the State of the Union address — said Mr. Bush's offer delighted him, and he hoped to see it matched by European and Arab nations. In that case, he said, "We would see a real assault on AIDS."