An AIDS patient’s hand is examined by a health care worker September 20, 2000 in the Strand hospice near Cape Town, South Africa. South Africa has a monumental health crisis with its AIDS epidemic and many families haven’t the means to take care of relatives who are ill with the disease. Photo: Getty Images/Fanie Jason/Liaison/font>

Health GAP and its allies were a leading voice in the yearlong negotiations that pushed the United States to pass legislation that they say goes beyond an increase in funding—Mr. Bush’s original proposal authorized only $30 billion—to address the critical lessons of the past five years of global AIDS programs. July 30 Health GAP activists in particular applauded the bill’s new support for efforts to correct the shortage of health workers that has frustrated efforts to scale up access to care and treatment.

More than half the program’s bilateral aid would have to go toward AIDS treatment and care.

The bill sets a goal of putting two million people into AIDS drug treatment and includes a goal to recruit 140,000 new health care workers.

The bill also calls for supporting poor countries’ efforts to achieve 2.3 doctors, nurses and midwives per 1,000 country residents, with direct support to train and retain 140,000 new health workers. In addition, the bill places an emphasis on training and retention of new doctors and nurses.

The July 30 reauthorization also strengthened the focus on women and girls, a factor that groups highlighted as a welcome policy framework for the bill.

“This important legislation boldly recognizes that women and girls are at the center of the global HIV epidemic,” said Geeta Rao Gupta, president of the International Center for Research on Women. She added that, while far from perfect, the President’s Emergency Plan for AIDS Relief “will significantly bolster the reach and effectiveness of the U.S. global AIDS program and will strengthen its priority to women and girls, laying out stronger measures to hold it accountable.”

Ms. Gupta also commended the bill for addressing “social factors that exacerbate women’s and girls’ risk of HIV infection,” such as gender-based violence and economic opportunities for women.

The International Center for Research on Women’s “research shows that when women and girls have access to education and economic resources—such as the availability to earn a living or own their own homes or land—remarkable changes occur in their lives as well as in their communities. They are less likely to marry as children, domestic violence diminishes, they are less economically dependent on men—and as a result, vulnerability to HIV decreases,” she said.

Despite recognizing the landmark status of the legislation in the global AIDS movement, activists have serious criticisms.

Following her praise of the bill’s steps toward real solutions, Ms. Gupta stated: “We are very disappointed that the final bill compromises women and girl’s rights to full information and services related to sexual and reproductive health.”

Health GAP highlighted abstinence-only funding as a major area of concern in the bill. The Hyde/Lantos Bill does overturn a previous requirement that one-third of prevention funding be directed toward abstinence-only programs.

However, to the dismay of grassroots organizations, this has been replaced by a “reporting requirement” which mandates that the Office of Global AIDS Coordinator submit a report to Congress if a country with a generalized epidemic spends less that 50 percent of sexual prevention funding on programs promoting abstinence and faithfulness.

Activist groups also cautioned that the bill only authorizes spending the $48 billion. During each of the next five years, Congress will actually have to appropriate the money in what is a separate process.

Although the bill was signed into law, Congress is not providing the money to implement it until fiscal year 2009.

“We deeply appreciate the hard work of everyone involved, in the Congress and the White House, which has led to this crucial legislation, yet, in terms of funding, it appears to be more rhetoric than reality,” said Dr. Paul Zeitz, executive director of the Global AIDS Alliance.

The Global AIDS Alliance also said, “President Bush should also move to immediately implement the bill’s provisions, such as by lifting immigration restrictions on people who are HIV-positive.”