To the editor:

The quality of analysis contained in “Wait of the world falls on Bush's ambitious AIDS Plan” (Nat. Med. 9, 808; 2003) falls far short of the standards one would expect from Nature Medicine. First, the article's attempt to create uncertainty about President Bush's commitment to his stated goal of a five-year, $15 billion global AIDS program ignores our oft-stated position: to be effective, a large infusion of new funds for HIV/AIDS in Africa and the Caribbean needs to be 'ramped up' over time. This approach allows countries the time to expand their ability to effectively use resources of this magnitude in a proactive and strategic manner. It is a matter of public record that future budget requests will increase such that, at the end of five years, an average of $3 billion a year is spent. Any practicing AIDS physician (and I am one) knows that HIV/AIDS treatment is a complicated matter requiring considerable infrastructure and training. Our analysis holds that less money will be needed in the first years of this program than in later years, when large numbers of patients will be receiving costly antiretroviral medications.

Second, you incorrectly report that one-third of funds will be used for abstinence prevention programs. The legislation is clear that about 20% of the total funding will be spend on prevention and, of that amount, in the last two years of the program, one-third will be spent on abstinence programs.

Third, if the Global Fund to Fight AIDS, Tuberculosis and Malaria is in a precarious position, it is not because of lack of support from the US. This administration currently provides 41% of its operating revenues and has pledged an additional $1 billion of support over the next five years.

Finally, the Elizabeth Glaser Pediatric AIDS Foundation's suggestion that this administration “may be forced to keep its word” has no factual basis. President Bush was not forced to make global HIV/AIDS a central issue in the State of the Union Address, to aggressively support legislation to deliver the largest disease-specific global public health campaign in history, or to make the largest contribution to the Global Fund. The president is leading the world in the fight against HIV/AIDS because it is, and has always been, the right thing to do.