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A little over a year ago, President Bush announced an ambitious plan to triple funding for AIDS prevention and treatment efforts, to $15 billion. On December 1, World AIDS Day, a coalition of religious leaders called on the administration to keep its promises and appropriate the money.

Anne Peterson is a former missionary doctor to Zimbabwe and Zaire who was appointed by the Bush administration as head of global health for the Agency for International Development (USAID). She spoke with Timothy C. Morgan, CT's deputy managing editor, about what she believes are the key ways to push the administration's AIDS policy forward.

What is the best way to spend money fighting the AIDS pandemic?

It's going to be a matter of keeping the balance. How do we begin to do treatment, deal with all of the difficult systems issues, make treatment available fairly—while still not losing the key prevention messages, as well as the orphan care and dying-patient care?

If we ever want to be able to address all of the treatment needs for people living with HIV and AIDS, then we have to work desperately hard on prevention. We have to make sure there are the fewest number of people getting HIV/AIDS so that we can manage to do that scope of treatment. So we need to do both, and we need to do them carefully and effectively and fully.

The promise that I can make is that whatever Congress chooses to appropriate, we will work very, very hard to make sure it is very well used.

The other bottom line is, whether it's AIDS or whether it's child health or tuberculosis, or infectious disease, or agriculture, the scope of the need out there is way more than the available resources. So there isn't a single area of international endeavor that couldn't use more funds.

Is condom use effective against HIV?

Condoms clearly can reduce transmission of HIV/AIDS sexually. The question is how correctly and consistently they are used, and by whom and where. We have evidence that shows that if couples—in which one is HIV-positive and the other is negative—use the condoms correctly every single time, they get a lot of protection. This is especially true for married couples. Evidence from Thailand and Cambodia shows that 100 percent condom use in brothels, together with reducing the number of partners, made a huge difference for an entire country.

Are condoms perfect? No. Are they 100 percent effective? No. Do people always use them correctly and consistently? No. But there is a role. This can be an effective tool in specific situations. So for high-risk populations, for encounters with a nonregular partner, they are a good idea; they are better than nothing—as long as you make clear that they have to be used consistently and correctly.

Now the flip side. When I was in Kenya in the '80s there was the question, "Why do the Americans keep bringing condoms to us? This doesn't fit with our culture." In a generalized epidemic, 50 to 69 percent of new infections are in youth. For most of that population, abstinence—delaying sexual activity—is a fully appropriate message. So is "zero grazing," the emphasis on remaining sexually faithful in ongoing relationships.

Such messages reduce the number of partners, thus reducing exposure to the disease. We have seen in places like Uganda, and now starting in Kenya, that people will respond to such messages. In a generalized epidemic, this is the strategy I would recommend most strongly.

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February 2004, Vol. 48, No. 2