Unlikely Allies Influenced Bush To Shift Course On AIDS Relief

An unlikely coalition of Christian evangelicals and liberal activists joined forces to help persuade President Bush to announce a remarkable turnabout this week in his administration's approach to the international AIDS crisis -- a tripling of U.S. spending on AIDS relief.

Bush surprised even many Republicans when he used his State of the Union address on Tuesday to call on Congress to spend $15 billion over the next five years to help countries in Africa and the Caribbean fight the pandemic.

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The announcement represented a marked change from the position shortly after Bush took office, when a top official publicly questioned the wisdom of trying to save the lives of Africans who had contracted HIV. Officials said then that money should be spent on preventing the spread of the disease in Africa but would be wasted on expensive anti-AIDS drugs because African health systems were not equipped to dispense the medicine properly.

Now the president is proposing that Washington spend lavishly on the AIDS pandemic in Africa and the Caribbean, supplying drugs to 2 million HIV-infected people and caring for 10 million others, including orphans whose parents died of AIDS.

Authorities on the disease said those figures may be overly optimistic unless the price of drugs falls. Even so, Jeffrey Sachs, a Columbia University economist who is the AIDS adviser to U.N. Secretary General Kofi Annan, said: "This is an enormous breakthrough. It's the first time in the history of this pandemic that we are seeing a commitment for anything on the scale that is necessary."

Few people outside Bush's inner circle knew of the president's growing interest in the issue, and his aides said that to keep his surprise, they deliberately avoided consulting many people outside the White House. Officials said that, in fact, the policy had percolated for months at the higher level of the administration, fueled in part by quiet lobbying from evangelical Christians and AIDS activists, special interest from key Bush advisers and a push from the new Senate majority leader, Bill Frist (R-Tenn.).

Administration officials said the AIDS epidemic has become a major cause for evangelical Christians, a crucial part of the president's political base because so many of them are affiliated with missions in Africa. Conservative politicians' concern about the disease has risen steadily over the past year as they became convinced that AIDS in the developing world is a massive humanitarian crisis that in most cases has nothing to do with the morality of the victims.

Frist, who spends part of each year in Africa as a medical missionary to people with AIDS, raised the issue of AIDS funding with Bush during a White House meeting last year. A congressional source said Bush responded knowledgeably, even mentioning the names of specific drugs.

The source said Bush replied, "I want you to show me how this money can be usefully spent and not just going down a rat hole, and I'm willing to put real money on the table."

Administration officials said politics was not the major reason for the AIDS initiative but acknowledged there could be beneficial ripple effects, especially in helping burnish the country's image abroad. The AIDS announcement could also remind moderate voters of Bush's claim to be a compassionate conservative at a time when his administration is tacking right on economic policy, judicial nominations and other issues.

A senior administration official said yesterday that the pledge "far outstrips anything that has been done in the past by any government" in AIDS treatment. Bush told an audience in Grand Rapids, Mich., yesterday that he views the project as a chance for "a moral nation" to use its wealth and ability to help "solve unimaginable problems, to help the people who are needlessly dying."

"We can make a huge difference," he said. "I want people to step back at some point in time and say, 'Thank God for America and our generosity, as lives were saved.' "

Bush's plan calls for spending $2 billion in the fiscal year that begins Oct. 1. About $10 billion of the $15 billion total would represent new commitments. Bush designated just $1 billion of the total for the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria.

Some AIDS experts complained that the administration's desire to control most of the money undermines the purpose of the fund, which is to assure that donations from rich countries are channeled in a coherent and cost-effective manner.

Anil Soni, adviser to the Global Fund's executive director, said that Bush was "taking a unilateral approach" that could hamper efforts to care for victims across all borders.

Nevertheless, Steven Radelet, a scholar at the Center for Global Development, echoed many specialists in the subject when he said, "The administration has come a long way in the last two years." A big factor behind its new approach, he said, was mounting evidence that AIDS treatment can work in Africa.

Administration officials said Bush, who had planned to announce the effort during a trip to Africa that had been scheduled for this month but was postponed, was convinced of the scale of the crisis in part because of trips to Africa last year by the outgoing Treasury secretary, Paul H. O'Neill, and by Commerce Secretary Donald L. Evans.

Evans said that he told Bush about the heartbreaking scourge he had witnessed and that Bush believes passionately that "we're here to serve other people and love our neighbors, and these are our neighbors."

The effort was championed inside the West Wing by Deputy Chief of Staff Joshua Bolten, who told a colleague several months ago, "We need to do something major on this." Michael Gerson, Bush's chief speechwriter, also took an early interest in the issue, and an administration official said he has talked for months about "the importance of speaking to this as a moral matter."

Several administration officials have become friends of Bono, the lead singer of U2, who said in an interview from Dublin that Bush's announcement shows how the world has changed. "If you think back just six months or a year, conservatives, especially religious conservatives, were very skeptical about this, and we had to explain that if you can't get the drugs, why would you test, and if you don't get people testing, we can't control the virus," Bono said. "All these points have sunk in."