SHACKLES ON THE AIDS PROGRAM

An expert committee has found that the Bush administration's
ambitious program to combat AIDS abroad is off to a good start but
warns that restrictions imposed by Congress or by the administration
are hampering efforts to slow the spread of the epidemic. These
inflexible barriers are often imposed for ideological, not health reasons.

The midcourse evaluation of the President's Emergency Plan for AIDS
Relief, or Pepfar, was delivered to Congress last week by a panel of
experts assembled by the Institute of Medicine, a unit of the
National Academy of Sciences. The program assists more than 120
countries in all, but concentrates its resources in 15 countries,
mostly in Africa.

Over all, the panel said Pepfar has demonstrated that AIDS services
can be rapidly scaled up (something many skeptics doubted) and now
needs to shift its emphasis from emergency relief to building the
capacity of affected nations to sustain the effort against AIDS for decades.

Programs to prevent the spread of H.I.V., the virus that causes AIDS,
are perhaps the most important tool in that long-term fight. Yet
Congress specified that only 20 percent of the money could be spent
on prevention, and one-third of that had to be used to promote
abstinence until marriage. More money has been spent in that area
than on other prevention activities, including distribution of
condoms and blocking mother-to-child transmission.

Another restriction that existed even before the creation of Pepfar
forbids the use of taxpayer money to give clean needles to injecting
addicts, while a third requires that all antiretroviral medications
be approved by the United States Food and Drug Administration, even
those already approved by the World Health Organization.

These restrictions needlessly hamper a program with great potential.
Congress should eliminate them and let health professionals devise
the most effective strategies.