"At the time President Bush announced the emergency plan in January of 2003, an estimated 50,000 people were all that were receiving anti-retroviral [anti-HIV] therapy in all of sub-Saharan Africa," Tobias said. "In the first eight months of the emergency plan, we supported treatment for about 155,000 HIV-infected adults and children in the focus nations."
The chairman of the committee, Representative Henry Hyde (Republican, Illinois), noted the need for a well-focused program.
He cited research by the United Nation's World Health Organization (WHO) showing that Africa has 14 percent of the world's population and 25 percent of the world's AIDS sufferers. The continent also has only a little more than 1 percent of the world's health-care workers.
But some in the hearing room did not see the Bush initiative as the best way to fight AIDS. They included a small group of protesters who briefly held up signs and chanted slogans like "Marriage is not a vaccine. Abstinence only is just a dream."
The protesters were referring to the core of the anti-AIDS program, which relies on what the Bush administration calls ABC -- an acronym for "abstinence, be faithful, and use condoms."
The vice chairman of the panel is Representative Tom Lantos (Democrat, California). With Representative Hyde, he co-sponsored the legislation that created the anti-AIDS initiative.
Lantos was critical of the program's reliance of religiously affiliated groups that are paid to educate Africans on how to prevent the spread of AIDS, usually with the emphasis on abstinence and fidelity.
Lantos noted that some of these groups have tried to pass on the fiction that condoms are not effective in preventing the spread of HIV/AIDS and have publicly burned condoms. He asked Tobias if the program would withhold payments from organizations that do so.
Tobias replied that all such groups are expected to follow the program's rules. He then said that, given the specifics of Lantos's question, such groups would be ineligible for funding.
There were similar complaints about regulations that, on moral grounds, forbid program officials to work with prostitutes. Representative Barbara Lee (Democrat, California) said it was time to repeal that part of the law.
Another witness was Geeta Rao Gupta, president of the International Center for Research on Women, an advocacy group. She said the U.S. program is not properly taking into account the fact that women and even girls are contracting AIDS as a result of rape or social coercion.
Gupta testified that in Africa men often marry teenage girls and often control their wives' property. She also said that rape is far more common there than it is in the West.
The ABC program is good as far as it goes, Gupta said, but it doesn't go far enough.
She told the committee that the ABC approach needs to be expanded: "The increase in women's HIV infections should serve as a wake-up call to alter the current U.S. approach to AIDS prevention, treatment, and care, to expand it beyond the ABC approach to what I call an 'ABC Plus' approach that includes investments in programs to increase the age of marriage; provide services to allow women as well as their spouses to be safe within marriage; reduce violence against women; and assure women's ownership and control of economic assets such as land and housing."
In the face of the criticisms and suggestions, Tobias said the best approach might simply be to share the responsibility. He noted that the United States is spending more in the fight against HIV/AIDS than all other countries combined.
Perhaps the world will start winning the war, Tobias said, when other countries make as strong a commitment as Bush and the U.S. Congress.