A legislative game of chicken is being played in the U.S. Senate over reauthorization of the United States international AIDS effort known as PEPFAR, the President's Emergency Plan for AIDS Relief.

Timing is important because quick reauthorization would give President Bush added clout in trying to get other industrialized nations to pony up funds in the fight against AIDS. The G8 summit of those leaders begins on July 7 in Japan, and many European nations have lagged in their funding for the effort.

The measure would spend $50 billion over five years in 15 of the nations hardest hit by the epidemic. It is a tripling of what was spent over the last five years. The bill has uncommonly broad bipartisan support, passing the House in June by 308-116, and the Senate Foreign Relations Committee by 18-3.

Opposition is led by the man who has become known as "Dr. No" for his opposition to spending measures. Conservative Senator Tom Coburn (R-Oklahoma) is a physician and former co-chair of the Presidential Advisory Council on HIV/AIDS. Six other colleagues back him. They say the level of spending is too much in this time of budget deficits.

Coburn also is concerned with "mission creep." The bill would allow PEPFAR to fund activities in other related areas, such as the provision of clean water.

"Will be turn PEPFAR into just another bloated, unmeasured and unmeasurable foreign aid program with no accountability and no real impact?" he asked.

Coburn wants to guarantee that at least 55 percent of the funds are spent directly on treatment. That provision was dropped from the current program, on the advise of its administrator and a review by the Institute of Medicine, to allow for more flexibility in help each individual country.

The opponents also decry a loosening of provisions requiring funding of abstinence-only prevention activities and allowing information on family planning activities, including abortion.

Coburn and colleagues have threatened to filibuster the bill and propose multiple amendments to it. Given the press of business and the shortness of the legislative calendar during this presidential election year the threat carries added weight.

As a result, Senate Majority Leader Harry Reid (D-Nevada) said that he will not schedule a vote so long as that filibuster threat is pending.

"The bill is currently stalled because Senate leaders seem reluctant to bring it to the floor absent an agreement that would limit debate and expedite a vote," the New York Times wrote in a June 21 editorial. It urged passage of the bill prior to the July 4 recess "to strengthen the president's hand at the G8 summit in early July."

As many have pointed out, PEPFAR is one of the few accomplishments of the Bush administration that is likely to be a positive aspect of his legacy. There is little incentive for Reid to use political capital where he will not benefit.

AIDS activists are seeking to put pressure on the Senate with a rally in Washington, D.C. on June 26. The theme is "Grow a Spine" and the targets are Senators Reid, Minority Leader Mitch McConnell (R-Kentucky), and presumptive presidential nominees John McCain (R-Arizona) and Barack Obama (D-Illinois). They want the Senate to stand up to Coburn and the others opposed to the bill.

Busses of protesters are expected to arrive in D.C. from New York and Philadelphia. Other actions are planned for Boston and Chicago on the same day.