President Bush wants a big boost in U.S. funding to fight HIV/AIDS in Africa. Mr. Bush says he saw first hand the successes of that funding on his six-nation tour of Africa last month.

President Bush did some long-distance lobbying on his Africa trip, telling U.S. taxpayers that their money is saving lives. At a joint press conference, Tanzania's leader, Jakaya Kikwete, said President Bush's Emergency Plan for AIDS Relief -- known as PEPFAR -- is making a real difference.

"Today, there are thousands of children who have managed to avoid joining the already long list of orphans and who continue to enjoy the love, guidance and support of their parents who are alive because of the AIDS care and treatment they get with the support of the PEPFAR initiative," said President Kikwete. 

President Bush said that is why he wants more money for PEPFAR. "The plan we put in place, the strategy we put in place is working. And Congress needs to make sure that this HIV/AIDS plan, PEPFAR, gets reauthorized for a five-year period of time. We don't want people guessing on the continent of Africa whether or not the generosity of the American people will continue," said Mr. Bush.

When President Bush took office in 2001, 50,000 Africans were on anti-retroviral drugs to combat AIDS. Now there are more than 1.2 million people receiving those medicines.

Mark Dybul is America's Global AIDS Coordinator. He says the President's comprehensive approach is meant to address the pandemic's toll on 15- to 40-year-olds who are the most productive and most sexually active part of society. "So the whole fabric of society is being torn apart and we recognize, the President recognized at the beginning, that part of a compassionate response is to deal with that," says Dybul.

Funding and Political Battles 

President Bush has asked Congress to double PEPFAR funding to $30-billion during the next five years. Opposition Democrats want to go even farther, proposing $50-billion for the program, which focuses on a dozen African nations as well as Haiti, Guyana and Vietnam. The new authorization would eliminate a controversial provision that one-third of the 20 percent of funds devoted to prevention focus on abstinence-only programs.

Victor Barnes is Director of the HIV/AIDS Initiative at the Corporate Council on Africa -- a private group promoting trade and investment between the United States and Africa. He says the abstinence-only provisions have had little impact on adults.

"When you are dealing with sexually active adults, abstinence-only portfolios are irrelevant. And so they have a very important place, particularly with youth and particularly with delaying the onset of sexual activity, which is a critical intervention. But the reality is that it has to be in conjunction with behavior-change interventions and strategies for working with sexually-active adults," says Barnes. 

The compromise reauthorization legislation would direct half of funds aimed at preventing sexual transmission of HIV to a balanced program of prevention built around the existing model known as ABC, or Abstinence, Be faithful, use Condoms.

John Bradshaw directs the Washington office of Physicians for Human Rights, a non-partisan group promoting health care through respect for human rights. He says he is pleased that the abstinence-only language has been removed. But he says it has been replaced by requirements that are still unclear.

"There is now a recognition that you can't have a one-size-fits-all kind of approach where you use abstinence-only programs and ABC programs only. You have to use whatever prevention methods the scientific evidence dictates," says Bradshaw. 

But Republican Representative Ileana Ros-Lehtinen of Florida says the deal preserves important principles of the original legislation that U.S. taxpayer funds not be used to pay for abortions. "PEPFAR funds can be, and in fact are, used to support HIV/AIDS prevention, voluntary testing and counseling and treatment programs at clinics which provide other services such as family planning. This is in keeping with the current practice. However, the agreement before us helps ensure that HIV/AIDS funding is not used to support family planning programs," says Ros-Lehtinen.  

Spending more on AIDS in Africa is not without its critics. Indiana Republican Congressman Dan Burton says African countries may not be able to efficiently use the additional funding. "The agencies involved and the people involved in Africa have not been able to absorb the $15-billion that was authorized before," says Burton. "I mean, they haven't even been able to use that and now we're authorizing $50-billion and my big question is, 'Can they absorb it?'"

The White House does not oppose the $50-billion funding level, but believes the President's original $30-billion request is more likely to be used effectively.

Long-Range Help

John Bradshaw says Physicians for Human Rights says that additional money can be absorbed by expanding Africa's health care infrastructure. The proposed reauthorization includes money to train 140,000 new health care workers who will improve the broader quality of care for all Africans.

The Corporate Council on Africa's Victor Barnes says that as PEPFAR moves forward, it must not only focus on treating new infections. It also needs to think beyond five-year plans to address those whose lives it has already saved.

"There is an ethical obligation that once you have put people on treatment that that treatment is available to them over their lifetime. And the notion that you are creating a chronic-disease response rather than an emergency response is a critical difference," says Barnes. 

The draft reauthorization strengthens programs for women and young girls who are most vulnerable to new HIV infections and currently account for nearly two-thirds of HIV cases in sub-Saharan Africa.

This story was first broadcast on the English news program, VOA News Now. For other Focus reports click here.