Senate leader who helped sway Bush to triple Aids relief

Every year Bill Frist, the US Senate majority leader, steps off a bush plane in Africa, his doctor's bag in hand. While other politicians are enjoying their holidays, he is saving lives in some of the forgotten continent's most miserable corners.

"Africa opened my eyes," the former heart surgeon from Tennessee once said. Now he has returned the favour by helping to open American pockets, big and wide, for Africa.

Last Wednesday President Bush promised to triple US spending on Aids relief, up to $15bn (£9bn) over five years. It caught even his most ardent critics off guard.

Before, the administration was regarded as having a see-no-evil approach. Budgets were watered down after mammoth battles. The Christian conservative lobby didn't like condoms. Mr Bush himself was seen as beholden to the pharmaceutical companies fighting against cheaper generic versions of their anti-retroviral drugs.

Now the President has pulled off a spectacular U-turn. He will supply the generics to two million people, mostly in Africa. Another 10 million, some of them Aids orphans, will receive American care. And he will encourage, even pay for, the distribution of condoms.

Aids activists are in shock. "We had no inkling this was coming," Dr Chris Ouma, a campaigner with Action Aid in Kenya, said. "But it is very welcome. It signifies a big change towards Africa."

The discovery that the eclectic coalition of Christian evangelicals and liberal activists had been quietly pushing for the changes behind closed doors was just as astonishing.

But the move was no surprise to Dr Frist, tipped by some as a future vice-president, who welded the two schools of thought together.

Dr Frist has been coming to Africa for the past six years, working mainly through Samaritan's Purse, the charity run by Franklin Graham, the son of the the evangelist Billy Graham.

He has a reputation as a conservative with a liberal's heart, at least on social issues – he has stood up to anti-abortion activists in the cloning debate, and joined the Irish rock star Bono and the Harvard economist Jeffrey Sachs as Africa's champions in Washington.

Just before Christmas he was in Kenya, visiting Aids victims in the Nairobi slums. "He sat in a mud hut for 45 minutes talking to a dying woman. It's got nothing to do with politics; he wasn't looking for her vote. He was just genuinely interested in her as a human being," Father Angelo D'Agostino said.

Testimonies from such trips have helped to sway hearts and minds among powerful Conservatives in Washington. Last year the famous foreign aid sceptic, Senator Jesse Helms, was reduced to tears in public when talking about Africa. Months later Bono went on an unprecedented four-country whirl with Paul O'Neill, then Treasury Secretary, who seemed moved by his experiences there.

The good works of Dr Frist and Mr Graham represents the soft edge of American evangelism abroad. Most Africans only see the Bible-thumping televangelists on stations such as Family TV in Kenya, where sharp-suited orators solicit contributions from viewers.

Some come to Africa from Europe or the United States, drawing massive crowds to rallies with promises of "miracle" cures. Smaller-scale African pastors have jumped on the bandwagon, offering similar cures to desperate Aids victims, who are so often disappointed.

The established churches have also been accused of being socially regressive. The Catholic Church maintains its opposition to condom use in public, and some bishops have actively spread misinformation about microscopic holes in condoms that allow the HIV virus to pass through.

But some priests and nuns working with Aids victims quietly disregard the sermons. "Whatever the church teaches, people are obviously using condoms all the time. And it's a very positive. The main thing is to keep the rate down," Father Gabriel Dolan said.

Bono's campaigning organisation, Data, has welcomed the new funding but said many questions remain unanswered about when it will materialise. Others have questioned why only $1bn of the additional $10bn is being channelled to the Global Fund on HIV, TB and Malaria.

African Aids workers have plenty of ideas about how Mr Bush's money should be spent. One of the key areas is anti-retroviral (ARV) drugs. Last year campaigners won a court battle in South Africa allowing the importation of ARVs. But although prices have fallen even further, the drugs are still too expensive. In Kenya, the monthly cost of generic ARVs has fallen to 2,500 shillings (£20), yet no more than 4,000 of the 2.2 million HIV sufferers are using the drugs, Jane Masiga of the Mission for Essential Drugs and Supplies said.

"That's the most painful thing. At our projects we find people who cannot even afford to eat, let alone buy the drugs," Dr Ouma of Action Aid said.

It is a reality of which Dr Frist is painfully aware.