Paul O'Neill stood in a hospital in South Africa one day in June, surrounded by wasting AIDS patients who could not afford the simple drugs that would keep them alive, and he changed his mind.

Looking at the ravaged bodies, the then-U.S. treasury secretary announced that treatment for AIDS would have to be a part of future U.S. strategy, that there was no reason to be sending people home to die for want of drugs easily available in the developed world.

He took that message home to the White House, and his road-to-Damascus moment became one of a series of factors that resulted in U.S. President George W. Bush's stunning announcement Tuesday night of a new funding initiative to fight HIV-AIDS in the world's poorest countries.

Mr. Bush said he would ask Congress for $10-billion in new funds over the next five years to fight the pandemic in Africa and the Caribbean.

Those involved in an intense lobbying effort said that in the past six months, the President heard from all quarters about AIDS in Africa. His treasury secretary, his spiritual counsellor, his most trusted security advisers, his Republican colleagues, all urged him to make history.

"It finally reached a tipping point," said a prominent activist who was part of half a dozen White House meetings last year.
The announcement was a total turnaround for the Bush administration, which had earned the wrath of AIDS activists for its minimal commitment to funding the fight against the disease.

Mr. O'Neill's trip to Africa, a fact-finding mission with Irish rock star Bono, was the most visible part of the lobbying effort. In speaking about treatment for AIDS patients, Mr. O'Neill broke with previous U.S. policy.

Until then, government initiatives had stressed prevention of the disease, not treatment, based on the argument that treatment was too expensive.

"When we went to that hospital . . . O'Neill was just appalled, and he went against administration policy. It definitely made it an issue within the White House," said an activist who was part of that visit. "They had to confront the issue of O'Neill's outburst."

The activists found more good fortune in Senator Bill Frist, who became Senate Majority Leader in late December.

Dr. Frist, a surgeon and public-health expert, has spent working vacations in Africa, and speaks eloquently about his first-hand experience of the devastation AIDS is wreaking there. He has also been pressing the President on the issue for more than a year, according to activists who work with him.

Secretary of State Colin Powell and National Security Adviser Condoleezza Rice proved to be strong allies, both arguing to Mr. Bush that Americans wanted more done to stop the pandemic.

Another voice came from Franklin Graham, son of evangelical Christian minister Billy Graham and one of the President's informal spiritual advisers. The younger Mr. Graham has worked with a Christian charity called Samaritan's Purse, which operates across southern Africa.

The U.S. medical establishment has been speaking up on treatment. In recent months the National Institutes of Health and the Centers for Disease Control and Prevention in Atlanta have both advised the government that treatment of HIV-AIDS is increasingly feasible and effective in very poor environments. They passed on the message that the drugs and treatment regimes have become much simpler in the past decade.

Several lobbyists also identified a crucial intelligence report last year as another central factor. The U.S. National Intelligence Council reported in October that without a strong global response, HIV prevalence in China, India, Nigeria and Russia would explode, posing a critical security risk as societies and nations collapse under the strain.

Then there's the Bono factor: The U2 frontman has waged a tireless backroom lobbying effort in Washington for the past three years. Bono and actors Ashley Judd and Chris Tucker went on a tour through nine U.S. states in December, dropping in on Krispy Kreme doughnut shops, church groups and high schools to talk about AIDS in Africa. Along the way the tour encouraged Americans to push their members of Congress to do more to fight AIDS.

"I think they really have been hearing from their constituents," said Lucy Matthew, who works with Debt Aids Trade in Africa and was part of that tour. "And it makes a difference."

One of the stops on the Bono tour was Wheaton College, an evangelical Christian school in Illinois and the alma mater of Mr. Bush's chief speechwriter, Michael Gerson. While there, Bono encouraged Mr. Gerson's former dean and teachers to write him a short note telling him how moved they were by the presentation.

Mr. Gerson is the key author of Tuesday night's speech.