With the stroke of a pen Wednesday, President Bush will do more for the battle against AIDS than any other leader, past or present.
The new law allocates an unprecedented $48 billion over the next five years to help treat and prevent AIDS, tuberculosis, and malaria. Of those funds, $39 billion is slated exclusively for the fight against AIDS, up from the $15 billion spent by the President's Emergency Plan for AIDS Relief (PEPFAR) over the past five years.
The announcement will be lauded at the 17th International AIDS Conference next week in Mexico City, but in the Horn of Africa – where the global food crisis and a current drought threatens to leave more than 15 million people hungry – aid workers and officials are concerned that Bush's quest to leave a legacy is overshadowing the most pressing needs.
"What is the use of keeping people alive with AIDS if they are just going to die of starvation?" says one high-ranking US official in Addis Ababa.
Ethiopia has pleaded with donors for an additional $300 million for food aid this year. Only half the needy are receiving food aid, and the rations have already been cut by a third to conserve resources. Yet, the country will receive $350 million from the US this year for fighting AIDS.
To be sure, US funding has helped Ethiopia to reduce its rate of infection to 2.1 percent last year from 2.5 percent ten years earlier. The global number of new infections was down to about 2.7 million people in 2007 from a peak of about 5 million new cases annually in the early 2000s, according to a report released Tuesday by the United Nations AIDS agency.
"We've achieved more in the past five years than in the previous 20 years," said Peter Piot, the agency's executive director. "But if we relax now, it would be disastrous. It would wipe out all of our previous investments."
PEPFAR has provided anti-retroviral treatment to more 1.73 million people in Africa, Asia, and the Caribbean. That led two years ago to the first annual decline in the number of AIDS deaths since the disease was identified in the 1980s.
The program has also helped prevent mother-to-child HIV transmission in nearly 12.7 million pregnancies and provide care for nearly 3 million orphans.
"The battle against AIDS will only be won only if we drastically reduce new infections, but there is finally some light at the end of the tunnel," says Marowa Evaristo, who heads the United Nation's AIDS program in Botswana.
Unfortunately for farmers in Ethiopia and other countries struggling with food shortages, the rise in funding for AIDS has been accompanied by a decline in resources for agricultural development, which have fallen from $818 million in 2002 to $538 million last year, according to figures available on the US Agency for International Development's website, though USAID officials deny any connection.
"The donor agencies and bilateral agencies have underinvested in agriculture over the last two decades," said USAID chief Henrietta Fore in a phone interview two months ago. "The USAID budget reflects that same trend."
President Bush has pledged $1 billion to help countries cope with the global food crisis. Of this amount, $150 million will be channeled into boosting agricultural production in poor countries in 2009.
Without new US funding, experts say, World Bank Director Robert Zoellick will never deliver the "New Deal" on agriculture he has vaunted as the solution to the global food crisis.
In Ethiopia, that would be a disappointment for people like Getachew Tikubet, who has a PhD in natural resource management and founded an organization 12 years ago to improve people's lives in the countryside.
His team has taught 25,000 farmers how to put their land and everything on it to better use, including the dung from their cattle.
Over the last six years, however, driven by the lack of funds, his organization has increasingly focused its efforts on helping improve the livelihoods of people living with HIV/AIDS.
Now, his team of 50 rural development specialists spends much of its time teaching community gardening to AIDS patients in urban areas, instead of working with farmers in the countryside.
"PEPFAR is symptomatic that the dollars that come from the US are driven by US politics and not fundamentally by the needs of recipient countries," says Michael Taylor, a senior fellow with the Washington-based Partnership to Cut Hunger and Poverty in Africa, which was founded in 2002 to mobilize public and private support in the United States for increased levels of assistance to Africa. According to Mr. Taylor, politicians are more eager to embrace a cause like HIV/AIDS, which resonates with US voters, than agricultural development, which has lacked champions in Western media.