Money to fight AIDS abroad caught up in budget wrangling

from The San Francisco Chronicle

Sabin Russell

A stalemate in Congress over financing the federal government through the remainder of the year could shortly upend progress in bringing AIDS drugs to needy patients in poor countries hardest hit by the global scourge.

At stake is nearly $1 billion in new spending for various programs to fight AIDS, tuberculosis and malaria abroad. The Bush administration had sought the money, and both houses in Congress were inclined to support the funding, but it could all disappear by the end of February without special consideration by lawmakers whose attention is now focused on Iraq.

Alarmed AIDS activists and key congressional supporters of the international program have begun to campaign to get the money approved, but now have barely one month to make their case.

"People are sweating right now. If we don't get a correction, the whole upward trajectory goes down. Momentum will be lost, and that's the hardest thing to gain again,'' said Dr. Paul Zeitz, executive director of the Global AIDS Alliance.

Dr. Mark Dybul, director of PEPFAR, the President's Emergency Plan for AIDS Relief, warned a Washington audience last week that unless Congress authorizes the additional money to continue expanding the program, new overseas enrollment in antiviral drug treatment -- at a rate of 50,000 new patients each month -- will have to stop by the end of February.

Because of an impasse over budget priorities that began during the waning days of the Republican-controlled Congress last fall, nearly all federal spending for this year has been frozen at 2006 levels. That creates special problems for programs, like PEPFAR, that were scheduled for big expansions in 2007.

Unless the new Democrat-controlled Congress makes an exception, PEPFAR will have to stay at last year's spending level through September -- leaving no money for new enrollment after February. As a result, 350,000 HIV-positive people slated to start AIDS drug treatment, most of them in Africa, won't get their medicine. Dybul estimated that 110,000 to 175,000 of them will die.

"That's what we are talking about. It's not just enrolling people on therapy,'' he said during a meeting of the Global Health Council. "It's people who will die -- they're gone.''

Dybul also estimated that without the additional money, 23,000 children will become infected at birth because services to prevent mother-to-fetus transmission of HIV "will pretty much have to halt.''

President Bush's PEPFAR program had targeted 2007 for a major scale-up of the drug treatment program, and he had requested that spending for the year grow to $4 billion from $3.2 billion in 2006.

Because the Republican-controlled Congress adjourned with much of its budgetary work incomplete, the daily business of government has been authorized with a series of continuing resolutions that leave spending at 2006 levels.

That stopgap strategy could become more permanent, however. Democrat leaders decided that, rather than renew the contentious budget debates that went nowhere in the fall, they would pass one more continuing resolution to keep nearly all federal spending levels flat until October. They would devote their energies instead to budget battles for the next fiscal year.

However, because spending has been restricted by continuing resolution budgets since the fiscal year began in October, AIDS advocates say the resultant savings have freed up at least $12 billion that could be distributed to programs Congress chooses to support. A massive lobbying effort is gearing up in hopes that about $1 billion of that be directed to pay for Bush's AIDS and malaria initiatives, as well as to pay some $90 million authorized for domestic AIDS programs under the Ryan White Care Act.

Rep. Barbara Lee, D-Oakland, a member of the Appropriations Committee, obtained 87 signatures in two days from other House members calling for $930 million in new spending for AIDS, tuberculosis and malaria programs -- the level supported last fall by the Senate Appropriations Committee.

"If you don't raise an issue, and don't organize around what is important, things do fall by the wayside,'' she said. "I can't take that chance.''

Lee said that she has not had any direct discussions with her Bay Area colleague, House Speaker Nancy Pelosi, but that AIDS has always been a top priority for the San Francisco Democrat.

Drew Hammill, a spokesman for Pelosi, said she is fully aware of the problem.

"She staunchly supports these programs, but we are also trying to achieve fiscal responsibility,'' he said. "The Republican Congress created this fiscal mess, and then punted this problem to us.''

Hammill said that a decision on the next continuing resolution does not have to be made until Feb. 15.

"We do have a little bit of time here,'' he said.

E-mail Sabin Russell at srussell@sfchronicle.com