In his State of the Union address on January 28, 2003, President George W. Bush pledged substantial U.S. financial support over the next five years to help fight AIDS in Africa and the Caribbean, (1) surprising his political allies and enemies alike by committing significant funds to an issue that had received limited attention in his Administration. (2) Congress passed legislation based on the Bush Plan in May 2003, and the President signed it into law on May 27, 2003. (3) While it is now up to Congress to appropriate the dollars necessary to implement the President's Emergency Plan for AIDS Relief ("Bush Plan"), (4) the President's bold proclamation before a television audience of both domestic voters and international viewers has elevated the political stature of the HIV/AIDS crisis, raising the hopes of countries most devastated by the virus and challenging other relatively wealthy nations to contribute their share.
The President framed the AIDS epidemic as a humanitarian crisis and U.S. AIDS relief as the noblesse oblige of a blessed nation. (5) While the desire to do the "right thing" undoubtedly forms a primary motivation for U.S. intervention, and the President's sincerity should not be doubted, it is also in the long-term business and security interests for the U.S. and other wealthy countries to support AIDS relief in Africa and other regions. AIDS decimates the labor forces of countries that are becoming increasingly important for multinational businesses. (6) Furthermore, a high AIDS infection rate in any state produces the conditions that may result in political instability, (7) which National Security Advisor, Condoleeza Rice, recently recognized as fomenting "greater sources of terrorism." (8)
The two major approaches to AIDS relief involve treating the infected with antiretroviral medication and containing the spread of the disease. The debate over the proper means of treating the disease has sparked major controversy in the World Trade Organization (WTO), as Western drug manufacturers have been criticized for insisting on the protection of their patents on anti-AIDS drugs against generic manufacturers in countries such as India and Brazil. (9) Drug companies initiated widely criticized lawsuits in defense of their drug patents in both the WTO and the courts of South Africa. (10) Although the litigation has been withdrawn, (11) the issue of drug patents highlights the dispute concerning the proper tactics of combating HIV/AIDS and underlines the potential for conflicting interests to hinder the effectiveness of AIDS relief efforts.
The Bush Plan attempts to address these problems by committing the United States to multiple bilateral partnerships with national governments, NGOs, faith-based groups, and other entities, and by creating a new Special Coordinator for International HIV/AIDS Assistance at the Department of State to oversee the administration of the program. (12) The Plan makes available $15 billion, including $10 billion in "new" money, (13) to treat the disease and prevent its spread (14) in fourteen African and Caribbean countries. (15) Part of the money will be used to purchase anti-AIDS drugs, the cost of which has fallen to about $1 per day. (16) It is uncertain, however, whether the United States will purchase anti-AIDS drugs directly from drug companies, or whether it will grant money to local NGOs or national governments for these purposes. Also unclear is whether the drugs will be purchased from U.S. patent-holders or from manufacturers of generic drugs.
The Bush Plan is also notable in its tepid support for a multinational approach, as ninety percent of the funds will be spent on projects directly administered by U.S. agencies. (17) The Bush Plan pledges only $200 million per year to the Global Fund to Fight AIDS, Tuberculosis, and Malaria, an independent entity created at the urging of UN Secretary-General Kofi Annan. The Global Fund has enjoyed substantial support in the Senate, (18) and members of the Senate Foreign Relations Committee have proposed donating more than the $200 million to the Global Fund pledged by the President in his speech. …