In the most dramatic moment of President Bush’s State of the Union Address last January he pledged a surprising $15 billion over five years to fight AIDS in Africa. His pledge represented $10 billion in new money and it caused congressional members of both parties to rise and offer sustained applause. They are still applauding, though somewhat less loudly now because that $15 billion is beginning to look more like a good idea than an actual commitment.

The latest United Nations report, “Accelerating Action Against AIDS in Africa,” released this week, describes the extent of the crisis. About 30 million people in Africa are infected with HIV; more than 15 million have died of AIDS. In Southern Africa, the HIV prevalence rate is among the world’s highest, above 25 percent in four countries. The need for funding treatment, and for funding that embarrasses other nations into giving, is acute.

That January evening, the president said, “tonight I propose the Emergency Plan for AIDS Relief – a work of mercy beyond all current international efforts to help the people of Africa. This comprehensive plan will prevent 7 million new AIDS infections … treat at least 2 million people with life-extending drugs … and provide humane care for millions of people suffering from AIDS, and for children orphaned by AIDS.”

But the $15 billion for five years is scheduled to start at $2 billion for the first year, and it is not difficult to calculate how many people will not get treatment and will die as a result of a conclusion drawn in Washington that the organizations serving the millions of Africans suffering from HIV and AIDS could not find a use for $3 billion so quickly. The problem is urgent and was described by the president himself, “Because the AIDS diagnosis is considered a death sentence, many do not seek treatment. Almost all who do are turned away. A doctor in rural South Africa describes his frustration. He says, ‘We have no medicines … many hospitals tell [people], You’ve got AIDS. We can’t help you. Go home and die.'”

Dr. Mark Kline of the Baylor College of Medicine, who has helped establish HIV/AIDS clinics for children in Romania and Botswana, knows this firsthand. And he knows the difference funding can make. With a private grant and just nine months, he oversaw the construction and opening of the Botswana Baylor Children’s Clinical Centre of Excellence to provide comprehensive care to children and their families. First lady Laura Bush visited the clinic soon after it opened and met some of the 1,000 children who have been treated there so far in a country with one of the world’s highest HIV rates.

Dr. Kline says that the hundreds of nongovernmental organizations and the excellent church groups working throughout Africa could easily use all the money first proposed for the first year, saving lives and suffering. This is more than Africa’s problem, even as AIDS treatment has made impressive advances in this country. HIV/AIDS harms individuals and it creates generations of orphans; it kills breadwinners, impoverishes villages and destabilizes governments. The president’s pledge raised hopes mightily in Africa and forced other developed nations to examine their own contributions.

The administration remains committed to providing the $15 billion, but wants to give more in later years and less now. If the commitment were to a highway project, this type of budgeting would be expected. But children with AIDS are dying today; they will not delay their deaths to accommodate a budget cycle. A Senate bill to raise the funding to $3 billion failed recently – Sen. Susan Collins, commendably, was the only Republican to support the bill – but others are planned. Sen. Olympia Snowe says she will support the higher level if it includes $1 billion in savings from elsewhere in the budget.

The senator’s concern about the deficit is commendable. A nation that can find tens of billions of dollars for tax cuts should also be able to find a small fraction of that to help the world’s most needy. The president was right to propose it and Congress should support him fully.