The President's Emergency Plan for AIDS Relief is one measure that politicians on Capitol Hill and in the White House have heartily embraced. In Monday night's State of the Union address, President Bush once again praised the foreign aid program, and recommended a boost in its funding. But some critics say there's less to that increase than meets the eye.
PEPFAR, as the President's Emergency Plan for AIDS Relief is often called, was first announced by Bush at his State of the Union address in 2003. At the time, it got a lot of good press for being one of the largest commitments by any government to a single disease.
It wasn't all sweetness and light. Conservatives wanted part of the money set aside for programs that preach abstinence before marriage. And Monday evening, in calling for a continuation of PEPFAR, which has paid for life-sustaining anti-AIDS drugs, the president also quietly asked Congress to maintain funding for abstinence prevention.
"I ask you to maintain the principles that have changed behavior and made this program a success. And I call on you to double our initial commitment to fighting HIV/AIDS by approving an additional $30 billion over the next five years," Bush said.
The AIDS relief plan has provided medicine for more than 1.4 million people in 15 African countries, the Caribbean and Vietnam, countries that have been hardest hit by the epidemic. Steve Morrison, of the Center for Strategic and International Studies, praised the president's new proposal as a highlight of the Bush legacy.
"It is calling for the enlargement to 2.5 million people that will be on life-sustaining therapy for HIV/AIDS," Morrison said.
In other words, nearly twice as many people with AIDS in developing countries would be covered as before. What's more, Morrison says, the president's AIDS plan has helped preserve America's good standing in the world and restore a reputation that has been tarnished by Abu Ghraib, Guantanamo and other events related to the war in Iraq.
"The achievements in global public health centered in HIV/AIDS are a standout in this period in the broader picture, when we have seen a dramatic slide and a need to recover from that," Morrison said.
But David Bryden of the Global AIDS Alliance, a frequent critic of the administration, says the president is playing tricks with the numbers. True, Bush is calling for $30 billion for the next five years, and that's twice as much as the president asked for in 2003. But Congress is already funding the global AIDS plan at that level, Bryden said.
"I think it is really quite ironic in the last year of his presidency he is pulling the rug out from under his program by proposing that it be flat funded for the next five years, at a time when the epidemic is still expanding and when we really should be aspiring to expand to meet the need of children who have been left out," Bryden said.
The United States isn't the only country contributing to AIDS relief, and the head of U.S. Global AIDS program, Mark Dybul, says that Bush has successfully used the program to get the rest of the world to respond.
"He took that commitment and went to the G8 and got them to commit to double it," Dybul said. "So because of the American people's commitment, the world is now committed to $60 billion over the next several years."
According to the World Health Organization, that would bring treatment to just half of the people who need it now. There are still more than 12 million people with AIDS in poor countries who need anti-AIDS medicine, and hundreds of thousands of HIV-infected children who need care.
President Bush delivered his last State of the Union address to Congress Monday night, a speech dominated by his description of a policy shift that he said had brought success and the promise of victory in Iraq.
The president said that a year ago, the situation in Iraq was approaching chaos. But he said the promotion of a new commander, Gen. David Petraeus, and a new "surge" strategy, combined with additional troops, had reduced violence and begun a process by which Iraqis might take over their own security.
"Some may deny the surge is working, but among the terrorists there is no doubt," Bush said. "Al-Qaida is on the run in Iraq, and this enemy will be defeated."
At the same time, the president warned that withdrawing U.S. troops from the situation too quickly could bring al-Qaida roaring back and allow sectarian fighting to resume. Bush said 20,000 troops were coming home and would not be replaced, but that further withdrawals would await the judgment of commanders in the field.
"While the enemy is still dangerous and more work remains, the American and Iraqi surges have achieved results few of us could have imagined just one year ago," he said.
Tax Cuts and the Stimulus Package
The president also urged Congress to pass the $150 billion economic stimulus package he had worked out with leaders of both parties in both chambers. He said it would relieve anxiety about a slowdown in job growth and a decline in the housing market. He did not use the word recession.
"To build a prosperous future," he said, "we must trust people with their own money and empower them to grow our economy. "
Congress could also send positive signals to consumers by extending tax cuts originally passed in his first term, the president said, rather than letting them expire, as scheduled, beginning in 2010.
Taking on Earmarks
As an added prescription, the president said Congress could wean itself off its habit of earmarking dollars in appropriations bills to pay for special projects in individual states and districts. He also chastised Congress for refusing to approve his proposals for overhauling Social Security and immigration laws, the main thrusts of his domestic policy in his second term.
"Illegal immigration is complicated, but it can be resolved," he vowed. "And it must be resolved in a way that upholds both our laws and our highest ideals."
The speech was about 50 minutes long and was interrupted often by applause, as is traditional in these events. Republicans, sitting to the president's left, often rose in standing and cheering ovations. Most Democrats remained seated through most of these, applauding politely. But the mood in the chamber seemed more cordial than in past years, perhaps because the Congress senses the administration winding down.
Here, NPR reporters analyze key aspects of the president's address, summarizing his proposals and their prospects.