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US and Britain look to slow pace of spending on AIDS

PRETORIA -- The pace of the world's fight against the three major infectious diseases, including AIDS, will largely be determined over the next two days in a closed meeting in Thailand.

The Bush administration and the British government have pushed for a slowdown in spending by the Global Fund to Fight AIDS, Tuberculosis and Malaria.

US officials say the organization should delay a new round of funding until next spring when it will have a more accurate accounting of its bank account. But officials at the World Health Organization and the Global Fund want to push ahead with a new round in two months, arguing that the fund always has given out money based on pledges from wealthy countries.

While the debate, which will take place at the Global Fund's meeting in Chiang Mai, Thailand, beginning today, is over the simple matter of a start-up date, the impact could be far-reaching, health officials said yesterday. The Global Fund has held three rounds of funding, committing more than $3 billion so far.

"Any effort at this point to slow things down would be disastrous," said Jim Yong Kim, a senior adviser to the WHO director general, Jong-Wook Lee. "Round four has to be right away. There's enough money to start."

The Bush administration has argued that funding for the AIDS fight should gradually increase in the coming years in part because many countries cannot absorb huge amounts of new money. But Kim argues that many millions of dollars could be spent wisely now on infrastructure -- mainly on the salaries and training cost of health workers -- so that health systems will be able to handle the devastating impact of AIDS.

Bush administration officials have declined to speak publicly about their concerns. A spokesman for Health and Human Services Secretary Tommy Thompson, who is chairman of the Global Fund's board, said the administration will not debate the matter in the media.

But one US senior health official in Washington, who asked not to be named, and WHO officials said that White House officials have become angry over the attention given to the Global Fund and WHO for their efforts in fighting AIDS. The US official said that the Bush administration believes its largely bilateral program promising $15 billion over five years -- $14 billion of which will be distributed directly to other countries -- will be the centerpiece of the AIDS fight and should receive the bulk of credit.

The White House earmarked $200 million for the Global Fund next year, while activists have called for a $1 billion annual donation. The House and Senate is now working on legislation that would add another $200 million to $300 million next year.

The US bilateral initiatives will not begin to be implemented until the middle of next year, lessening its impact on the WHO's plan to treat 3 million poor people with toxic antiretroviral drugs by the end of 2005. Now, just 300,000 people in poor countries receive those drugs, including just 50,000 in Africa. More than 42 million people worldwide are infected with HIV, some 70 percent of them in sub-Saharan Africa, and an estimated 3 million people are dying each year from AIDS-related diseases.

The rapid scale-up envisioned by the WHO depends on many organizations and countries working together and places a heavy emphasis on improving health infrastructure in some of the poorest parts of the world.

The Thailand meeting was shaping up to be a relatively quiet event until Global Fund officials heard from the Bush administration and British health officials about delaying the next round of funding. The fund had to borrow $101 million from donor contributions pledged next year in order to finance grants this year.

After word leaked out about the US and British objections, several AIDS activist groups this week began lobbying members of Congress and started a grass-roots campaign to start the fourth round of funding by December. "We see this as a defining moment in Bush's AIDS policy," said Paul Zeitz, head of the Global AIDS Alliance, an advocacy group based in Washington.

John Donnelly can be reached at donnelly@globe.com

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