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World Faces Major Challenges in AIDS Battle, US Says

The chief U.S. coordinator for HIV/AIDS programs says the United States is on track to meet President Bush's $15 billion, five-year AIDS initiative. However, Randall Tobias says the world faces major challenges in confronting the disease.

State Department global AIDS coordinator Tobias says money President Bush requested for the 2006 fiscal year beginning in October, about $3.2 billion, keeps the United States on track to meet the president's five-year goal.

President Bush announced his Emergency Plan for AIDS Relief in his State of the Union Address in 2003. It aims to help the worst-affected countries in Africa and the Caribbean in prevention and treatment, obtaining anti-retroviral drugs and generally strengthening their ability to fight the disease.

Key focus countries are: Botswana, Ivory Coast, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia. A 15th country, Vietnam, was added in 2004.

Mr. Tobias says 2006 will be the third year of steadily increased funding, against the background of a tighter budgetary picture overall for the U.S. government.

At the same time, he says he cannot report any major upward turn in the battle against an HIV pandemic that, in Africa alone, has infected 30 million people, including three million children under the age of 15.

"I wish I could report to you that the world has turned the corner on HIV/AIDS or that the hard part is behind us," he said. "But even with the encouraging results you will see in our first annual report, it is very true that we have a very, very long way to go."

Mr. Tobias says AIDS continues to kill about 8,000 men, women and children each day, with five million new AIDS infections each year, and women and girls disproportionately the victims of the disease.

President Bush based his AIDS initiative on the A.B.C. concept, which stands for Abstinence, Be Faithful, Condoms, an approach pursued with considerable success in Uganda among other places.

But the debate over A.B.C. continues. In Wednesday's hearing of the House Foreign Operations Subcommittee, Congressman Steve Rothman pressed Mr. Tobias on the effectiveness of condoms versus sexual abstinence in preventing AIDS.

Mr. Tobias says the A.B.C. concept has received what he calls growing endorsement from experts and has been proven to be the centerpiece of AIDS prevention.

Another lawmaker, Congressman Jesse Jackson Jr., says he is concerned about African countries not covered under the Emergency Plan, but which face high rates of AIDS infection

"Swaziland has an adult HIV infection rate of 38.8 percent, Lesotho 28.9 percent, Zimbabwe 24.6 percent, and Malawi 14.2 percent. All of these nations are non-focus countries. In fact, of the top four countries with the world's highest adult HIV infection rates, only one of them is considered a focus country. What is the administration's plan to [keep] up the commitment to combat the spread of HIV/AIDS in non-focus countries such as Zimbabwe, where HIV and AIDS is a threat to the country's economy and development?"

Mr. Tobias says the United States has not lost sight of needs in other countries, saying generally speaking U.S. funding to those not on the AIDS Emergency Plan list has increased, in addition to assistance from the Global Fund on AIDS, Tuberculosis and Malaria.

At the same time, Mr. Tobias acknowledges that actual contributions to the Global Fund, in contrast with pledges, are still lagging, and adds it is too early to tell if they will be sufficient to trigger the full U.S. contribution to the Global Fund of about $437 million.

Congress mandated that the U.S. contribution to the Global Fund be limited annually to 33 percent of the total. Last year, a shortfall in actual contributions from other governments resulted in a reduction of U.S. support of $88 million.