United States President George Bush's call for Congress to spend US$30 billion over five years to fight AIDS has won him an unusual level of praise from activists in Africa.

The current Emergency Plan for AIDS Relief (PEPFAR), a $15 billion, five-year campaign launched by Bush in 2003, has so far supported antiretroviral treatment for 1.1 million people in 15 focus countries, all but three of them in Africa. According to a press release issued by the White House, Bush's call for Congress to double funding to $30 billion for an additional five years, would maintain two million people on treatment and allow another 500,000 people to begin therapy.

Speaking on Wednesday, Bush described PEPFAR as "the largest commitment by any nation to combat a single disease in human history."

Adding that the money "will be spent wisely", he outlined a proposal to form "partnership compacts" with recipient countries where governments and civil society organisations would become responsible for making their own contributions to goals such as promoting gender equality, the rights of orphans and expanding health care services.

AIDS groups welcomed the announcement, particularly those that have faced uncertainty about the future of PEPFAR-funded programmes after 2008.

"The fact that they're not only talking about a continuation but an increase is clearly wonderful news," said Garth Japhet, executive director of Soul City, a South African nongovernmental organisation that uses television and radio programmes to communicate HIV/AIDS information and receives about 25 percent of its funding from PEPFAR. "It's certainly a programme that has made a huge difference in many people’s lives," he added.

Health Gap, a U.S-based organisation that advocates for the rights of people living with HIV, released a response to Bush's funding request, reminding him of the promise he and other leaders made at the G8 Summit in 2005, to achieve universal access to HIV treatment and prevention by 2010. Leaders from the Group of Eight industrialised nations are scheduled to meet in Germany next week, for their 2007 summit.
"The US share of the cost of keeping that promise will cost at least $50 billion over the next five years," said Paul Davis, a spokesperson for Health Gap. "$30 billion over five years would actually result in an overall decrease in the percentage of people with HIV on treatment."

PEPFAR's Deputy Coordinator, Ambassador Jimmy Kolker, responded that the rest of the world had to "step up".

"Unless others step up with increased contributions of their own, they’re right, we’ll be fighting a losing battle," he told IRIN/PlusNews. "We're already providing half of the resources going to global AIDS funding."

Health Gap and other AIDS activist groups have argued that the second phase of the PEPFAR initiative would be undermined by some of its "ideologically-motivated provisions". The requirement that a third of PEPFAR's prevention funds be spent on programmes that promote abstinence-until-marriage has come under particular fire.

"No amount of money will make up for the ideologically-driven prevention policies now promoted by PEPFAR," said Jodi Jacobson, executive director of the Centre for Health and Gender Equity. "This is not a prevention strategy, it is an exercise in unreality."

But Scott Billy, a technical advisor with the Society for Family Health, which receives PEPFAR-funding to run HIV counselling and testing services in a number of African countries, believes that PEPFAR's funding for abstinence programmes is not as restrictive as its critics suggest.

"What they’re saying is that it depends on who you’re talking to. If you're talking to a 14-year-old girl you talk about abstinence, if you're talking to a sex worker, you talk about condoms," he told IRIN/PlusNews. "With our counselling and testing programmes, there really haven’t been any restrictions on how we do things."

In seven out of PEPFAR's 15 focus countries, the abstinence spending requirement has already been waived, pointed out Kolker. The debate about whether or not that spending requirement and others would make it into the renewed plan was already ongoing, he added, "but the administration is not backing off from that, we’ve found it’s an effective use of money".

The process of getting the bill approved by Congress will be a lengthy one, said Kokler, "but the first reactions have been very positive and this programme has always had bi-partisan support, so we are optimistic."