By John Donnelly, Globe Staff, 2/24/2004

PRETORIA -- President Bush launched his global AIDS program yesterday by awarding multimillion-dollar grants to four US-based institutions, including $107 million to Harvard's School of Public Health, to treat those suffering from the deadly virus in three African nations.

The grant to Harvard is the largest received by the School of Public Health, easily surpassing a $25 million grant in 2000 from the Bill and Melinda Gates Foundation to help prevent the spread of HIV, the virus that causes AIDS, in Nigeria.

"Our intent has been to move as quickly as possible to bring immediate relief to those suffering the devastation of AIDS," said Randall Tobias, the US global AIDS coordinator, who announced the grants in Washington.

The first installments of Bush's $15 billion five-year AIDS fight come against a backdrop of recent allegations from activists critical of the administration's go-it-alone approach and a delay in releasing the money.

But for groups seeking grants, the selection process was surprisingly fast and offers the recipients some flexibility in buying generic medicines -- a critical point because generics are much less expensive than brand-name antiretroviral medicines.

The Bush initiative aims to dramatically increase the number of poor people being treated on the life-extending antiretroviral medicines. Now, anywhere from 50,000 to 100,000 people in sub-Saharan Africa are being treated; the precise number is difficult to pin down, mirroring the trouble estimating how many millions of people are infected with HIV or have died from AIDS, acquired immune deficiency syndrome.

The Harvard plan aims in five years to roughly double the number of people currently being treated in sub-Saharan Africa. Its goal is to put an additional 75,000 people on antiretroviral drugs in Nigeria, Tanzania, and Botswana.

"The amount of money is huge, and it will allow us to scale up pretty fast," said Phyllis J. Kanki, a professor of immunology and infectious disease at the Harvard AIDS Institute and the School of Public Health. Kanki, who directs the school's program in Nigeria, also will run the new project.

The other programs will be run by Catholic Relief Services, the Pediatric AIDS Foundation, and Columbia University's Mailman School of Public Health, and will focus on AIDS treatment and the prevention of the transmission of HIV from mother to child.

Bush first announced the initiative in his State of the Union address more than a year ago. In recent months, AIDS activists have criticized the slow process of releasing the funds.

Yesterday's announcement of the first $350 million in grants under the AIDS plan was made amid several other international efforts to expand AIDS treatment to the poor. The World Health Organization has launched a project to treat 3 million people by the end of next year, and similar programs are scheduled to begin in several countries -- mostly notably in South Africa, which is estimated to have up to 5 million people infected with HIV or AIDS.

Two senior US health officials said this first stage of the US plan is focused on what one called "low-hanging fruit" -- programs with the best bet of yielding quick, measurable results.

Many activists called on the United States to make large investments in the Global Fund to Fight AIDS, Tuberculosis and Malaria, but the Bush administration wanted to make its own funding decisions -- partly because of its concerns over how the money would be spent and partly because it has sought political credit for the initiative.

Many groups working on AIDS prevention and treatment said they were shocked by the administration's quick deadlines for this round of funding. The administration asked for proposals Dec. 1 from groups that had experience in at least three of the 14 countries eligible for funding. The deadline was Dec. 31, and the programs had to be designed to start Jan. 15.

The four recipients of the first grants received e-mail confirmation last weekend. Both the Pediatric AIDS Foundation and Columbia University will focus on preventing the spread of the virus from mother to child during delivery. Harvard and Catholic Relief Services, a Baltimore-based nonprofit organization, will address treatment needs.

Some pharmaceutical companies have objected to the use of generic medicines, and US trade lawyers have said that under some circumstances, a US supplier would not be legally able to buy generic drugs because of US patent laws.

Kanki, who has worked for nearly two decades on AIDS, said she plans to use generic antiretroviral drugs in Nigeria and Tanzania because those restrictions do not apply there.

"It's my understanding that we could use generics," she said. "We would like to go with what the country is going to go with."

Botswana pays for its own drugs as well as HIV testing, and it now buys brand-name medicines.

In the first year, the Harvard plan calls for treating 8,000 people in Nigeria, double the current number; 4,000 in Botswana; and 3,000 in Tanzania. The effort also will extend to improving laboratories and increasing the training of health workers to oversee the distribution of the drugs. Botswana's program, which has been hampered by a scarcity of trained personnel, will be particularly weighted toward teaching more health workers about managing AIDS cases.

Wafaie Fawzi, an associate professor of international nutrition and epidemiology at Harvard's School of Public Health, will help oversee the program in Tanzania, while Ric Marlink, executive director of Harvard AIDS Institute, will help lead the Botswana effort. In both Botswana and Nigeria, the Harvard projects have helped develop a cadre of professionals in AIDS work.

"It's not something where people can fly in and do it in three weeks," Kanki said. "It's a long process, getting to know people, trusting them, understanding the country, and doing things in line with what the country needs and wants."

Still, she added, "It's a really daunting task to do what we are proposing to do. This is at a scale that we have never tackled before."

John Donnelly can be reached at donnelly@globe.com.

This story ran on page A1 of the Boston Globe on 2/24/2004. © Copyright 2003 Globe Newspaper Company.

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