GAO says Bush's AIDS plan is marked by confusion, red tape

A report released Tuesday by the nonpartisan Government Accountability Office suggests that President Bush's five-year, $15 billion international AIDS program is marked by widescale confusion, particularly over whether generic antiretroviral drugs can be bought with U.S. AIDS money. The report, based on a yearlong audit of the President's Emergency Plan for AIDS Relief, finds that the confusion over generic drugs makes it difficult for U.S. officials to help craft larger national treatment programs in developing countries that receive PEPFAR funds. Four of the countries included in the program already purchase generic anti-HIV drugs to treat their HIV-positive citizens, and health officials involved with PEPFAR are unsure whether U.S. funds should bolster existing generic-drug efforts or be used to set up separate brand-name drug programs. Another requirement that all bulk purchases of more than $100,000 be preapproved by Washington, a process that can take months, also is interfering with efforts to buy antiretroviral drugs in bulk quantities for distribution in poor nations. Because of the confusion and red tape, some countries are using PEPFAR funds only for administrative and training purposes, while relying on other funding sources to purchase anti-HIV drugs. The GAO report was requested by Rep. Jim Kolbe (R-Ariz.) and included interviews with U.S. Agency for International Development and Centers for Disease Control and Prevention officials in 14 of the 15 countries included in PEPFAR. Kolbe, who acknowledges that there are problems with the program, responded to the GAO report by saying, "It's way too early to make any definitive judgments." But some AIDS activists greeted the report with outrage. "Bush is selling compassion to American voters this election year, but the real agenda of the White House has been to create a slush fund for U.S. drug companies," said Paul Davis, domestic policy director for the U.S.-based advocacy group Health Global Access Project. "The U.S. government's own watchdog group says the Bush program is not working. United Nations secretary-general Kofi Annan says the program is not working. Scientists, fund recipients, and activists say the program is not working. It's time for the president to admit what is clear to the world. PEPFAR is not working."