JOHANNESBURG, South Africa — The U.N. special envoy on AIDS in Africa welcomed President Bush's proposed $15-billion AIDS initiative Wednesday, calling it a sign of the U.S. commitment to fighting the epidemic that "opens the floodgates of hope."
But the response from South Africa -- which has the world's largest number of people living with AIDS or HIV -- was muted.
"I think that is welcome," Deputy President Jacob Zuma said at a news conference on peace efforts in Burundi. "I don't think we have a problem, but it has to take into account that countries like South Africa have specific programs.... If that aid fits into those programs, that would be accepted."
South Africa has been widely criticized for a slow and ineffective response to the AIDS crisis. On Wednesday, U.N. envoy Stephen Lewis said the U.S. package should encourage the government to use its allotment of the aid to provide its citizens with anti-retroviral drugs that dramatically reduce the impact of the virus "at the earliest possible moment."
"The government has always pleaded dollars," Lewis said. "It is now clear that from the world community, the dollars are on the way."
But Zuma said it was far from clear that the aid, which also will go to Caribbean nations, will allow broad access to antiretroviral drugs for South Africans.
"One does not know what are the conditions of the money, or where it will be allocated," he said.
Other African officials also believe that disbursement is a crucial issue.
"We appreciate the move and the gesture, but will it be enough? We don't even know how the money will be used and who will get what," said Najib Balala, Kenya's social services minister.
Olive Shisana, executive director of an AIDS monitoring group created by the South African Parliament, said she feared that too much of the money could be siphoned off into the salaries of U.S. consultants. She recommended that the money be channeled through the Global Fund to Fight AIDS, Tuberculosis and Malaria, a consortium of nations and nongovernmental organizations supported by the United Nations.
Nearly 30 million people in sub-Saharan Africa are infected with HIV, or the human immunodeficiency virus, which causes AIDS -- a huge share of the 42 million infected worldwide. Five million of South Africa's 44 million people are HIV-positive. In neighboring Botswana, nearly 40% of adults are HIV-positive.
Bush has asked Congress to approve $10 billion in new funds to be added to the current funding of $5 billion over five years to prevent 7 million new infections, provide AIDS drugs to 2 million people and care for infected people and children orphaned by the epidemic.
In Washington, Peter Mugyenyi, director of the Joint Clinical Research Center in Uganda and an expert on AIDS in Africa, said he hopes the U.S. spending plan will lead other nations to take similar steps. He cited Japan, Europe and "rich Arab countries" as possibilities.
Africa has an estimated 11 million AIDS orphans, 660,000 in South Africa, far outstripping the resources of the organizations that try to care for them.
At the news of the Bush announcement, "my first thought was, 'I wonder where the money will be going?' " said Dr. Jana Oosthuizen, 29.
Oosthuizen works for the Topsy Foundation, which cares for 711 AIDS-affected families and runs a hospice for AIDS orphans -- and occasionally takes in their dying mothers -- at a former coal-mining center an hour from Johannesburg.
"I hope the money will be used in antiretroviral treatment, because if not, there will be more and more orphans," Oosthuizen said.
The lack of broad access to antiretroviral drugs in South Africa is a huge bone of contention among AIDS activists. The drugs allow many to significantly recover and return to normal life.
"One of the issues is that medicines are far too expensive," said Zuma. "Maybe this aid can come with an effort to reduce the cost of the medicines."
Some diplomats blame South Africa's slow response to the AIDS crisis on President Thabo Mbeki, who was once quoted as saying he did not believe there was a link between HIV and AIDS -- although international officials say he now tells them his words were misinterpreted.
"There are disagreements about the AIDS policy," U.N. envoy Lewis said. "But if the U.S. decides to distribute the money itself, I would think that a good chunk of the money would go to South Africa."
In the United States, the spending initiative drew calls for an increase in funding for domestic AIDS programs.
The Human Rights Campaign, based in Washington, expressed concern that Bush did not address those needs.
Administration officials said Bush will not cut domestic AIDS programs in the fiscal 2004 budget that he will send to Congress on Monday. But they would not say whether more money will be sought. The request for fiscal 2003, as yet unapproved, is about $16 billion.
Times staff writer James Gerstenzang in Washington contributed to this report.